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Cohen O, Lange K, Budnik I, Tamarin I, Brutman-Barazani T, Barg AA, Rosenberg N, Lubetsky A, Kenet G, Levy-Mendelovich S. Application of a clinical decision rule and laboratory assays in pediatrics: Adult heparin-induced thrombocytopenia. Pediatr Blood Cancer 2022; 69:e29929. [PMID: 35997577 DOI: 10.1002/pbc.29929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Heparin-induced thrombocytopenia (HIT) is rare among pediatric patients. The diagnosis of HIT depends upon clinical decision tools to assess its pretest probability, supported by laboratory evidence of anti-platelet factor 4 (anti-PF4)/heparin antibodies. AIMS To compare the use of the 4Ts score clinical decision tool, clinical characteristics, and laboratory findings between pediatric and adult patients with suspected HIT. METHODS We compiled all pediatric patients in our center for whom HIT testing was performed during the years 2015-2021. These were compared with a cohort of consecutive adult patients. Laboratory diagnosis of HIT was performed with particle gel immunoassay (PaGIA) as screening test and confirmed by an automated latex-enhanced immunoturbidimetric assay (LIA) and/or by functional flow cytometry assay (FCA). RESULTS The cohort included 34 children (under 18 years) and 105 adults. Adults mostly received heparins for thromboembolism prophylaxis and treatment (72.4%, n = 76), and were more frequently treated with low-molecular-weight heparin (LMWH). Children were mostly exposed during cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO, 61.8%, n = 21), and were more frequently treated with unfractionated heparin (UFH). Compared with adults, children had significantly higher 4Ts scores. Nevertheless, adults had a slightly higher rate of a positive diagnosis of HIT. Six out of 16 adults with confirmed HIT presented with thrombosis (37.5%), whereas all three pediatric patients with HIT presented with thrombosis (p = .087). CONCLUSIONS 4Ts scores are higher in children compared with adult patients for whom laboratory tests for HIT were obtained. A potentially higher incidence of thrombosis in children with HIT may be attributable to the severity of underlying illness.
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Affiliation(s)
- Omri Cohen
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Kfir Lange
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ivan Budnik
- Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ilia Tamarin
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel HaShomer, Israel
| | - Tami Brutman-Barazani
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Arie Barg
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nurit Rosenberg
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aharon Lubetsky
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Kenet
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarina Levy-Mendelovich
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Talpiot Medical Leadership Program, Sheba Medical Center, Tel HaShomer, Israel
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Besch G, Ilic D, Ginet M, d’Audigier C, Nguyen P, Ferreira D, Samain E, Mourey G, Pili-Floury S. Identification of Heparin-Induced Thrombocytopenia in Surgical Critically Ill Patients by Using the HIT Expert Probability Score: An Observational Pilot Study. J Clin Med 2022; 11:jcm11061515. [PMID: 35329842 PMCID: PMC8951334 DOI: 10.3390/jcm11061515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Heparin-induced thrombocytopenia (HIT) remains a challenging diagnosis especially in surgical intensive care unit (SICU) patients. The aim of the study was to evaluate for the first time the diagnostic accuracy of the HIT Expert Probability (HEP) score in the early identification of HIT in SICU patients. Methods: The HEP and 4Ts scores were calculated in all patients with suspected HIT during their stay in our SICU. The diagnosis of HIT was finally confirmed (HIT+ group) or excluded (HIT− group) by an independent committee blinded to the HEP and 4Ts score values. The primary outcome was the sensitivity and specificity of a HEP score ≥ 5 for the diagnosis of HIT. The secondary outcome was the area under the ROC curve (AUC) of the HEP and 4Ts scores in the diagnosis of HIT. Results: Respectively 6 and 113 patients were included in the HIT+ and HIT− groups. A HEP score value ≥ 5 had a sensitivity (95% confidence interval (95% CI)) of 1.00 (0.55−1.00), and a specificity (95% CI) of 0.92 (0.86−0.96). The AUC (95% CI) was significantly higher for the HEP score versus for the 4Ts score (0.967 (0.922−1.000) versus 0.707 (0.449−0.965); p = 0.035). Conclusions: A HEP score value < 5 could be helpful to rule out HIT in SICU patients.
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Affiliation(s)
- Guillaume Besch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France; (D.I.); (M.G.); (D.F.); (E.S.); (S.P.-F.)
- EA3920, University of Franche-Comte, 3 bvd Alexander Fleming, F-25000 Besancon, France
- Correspondence:
| | - Dejan Ilic
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France; (D.I.); (M.G.); (D.F.); (E.S.); (S.P.-F.)
| | - Marc Ginet
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France; (D.I.); (M.G.); (D.F.); (E.S.); (S.P.-F.)
| | - Clément d’Audigier
- Etablissement Français du Sang Bourgogne Franche-Comté, Hemostasis Department, Laboratoire de Biologie Médicale et de Greffe, F-25000 Besançon, France; (C.d.); (G.M.)
| | - Philippe Nguyen
- Department of Haematology, CHU Robert Debré, F-51000 Reims, France;
- EA3801, IFR-53, Reims Champagne-Ardenne University, F-51000 Reims, France
| | - David Ferreira
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France; (D.I.); (M.G.); (D.F.); (E.S.); (S.P.-F.)
- EA481, Integrative and Clinical Neuroscience Laboratory, University Hospital of Besancon, F-25000 Besancon, France
| | - Emmanuel Samain
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France; (D.I.); (M.G.); (D.F.); (E.S.); (S.P.-F.)
- EA3920, University of Franche-Comte, 3 bvd Alexander Fleming, F-25000 Besancon, France
| | - Guillaume Mourey
- Etablissement Français du Sang Bourgogne Franche-Comté, Hemostasis Department, Laboratoire de Biologie Médicale et de Greffe, F-25000 Besançon, France; (C.d.); (G.M.)
- Department of Clinical Hemostasis, University Hospital of Besancon, F-25000 Besancon, France
| | - Sebastien Pili-Floury
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France; (D.I.); (M.G.); (D.F.); (E.S.); (S.P.-F.)
- EA3920, University of Franche-Comte, 3 bvd Alexander Fleming, F-25000 Besancon, France
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