Heparin-Induced Thrombocytopenia-Associated Thrombosis in Pediatric Intensive Care Patients

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Fig 1.
Flowchart of patient inclusion.
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Fig 2.
HPF 4 antibody levels in patients with HIT and thrombosis (N = 14) and controls (N = 27). Data are presented as percent of cutoff optical density values for adults. The bar indicates the median value for each group. In 8 HIT-thrombosis patients with results below the cutoff for adults (100%), values were significantly higher than in controls (P = .004, Mann Whitney U test).

TABLE 1.

Characteristics of Patients With HIT and Thrombosis Compared With Controls (PICU Patients Without Clinical Evidence of HIT or Thrombosis)

Variable	HIT-Thrombosis	Controls
Number	14	27
Median age (mo; interquartile range)	6.5 (1–33)	4.3 (2–19)
Percentage of males	64%	59%
Heparin exposure before sample taken (d; mean, SD)	14 ± 10.5	15 ± 9.5
Storage time before analysis (mo; mean, SD)	17 ± 6.2	19.5 ± 5.5
Platelet count, mean (range) ×10⁹/L	58 (27–191)	336 (52–570)

TABLE 2.

Characteristics of 14 Patients With HIT-Associated Thrombosis

Gender, Age at Admission	Admission Diagnosis	Site of Thrombosis	Hep Exp	Previous Hep	Platelet Decline (%)	Platelet-Nadir × 10⁹/L	HPF4-AB
Female, newborn	Open heart surgery	Left common iliacal artery	6	No	51	191	153
Female, 6 mo	Open heart surgery	Right femoral artery; vena innominata	5	Yes	88	46	134
Male, 10 mo	Open heart surgery	Superior vena cava	10	Yes	55	46	112
Female, 15 mo	Open heart surgery	Right subclavian vein	16	Yes	65	123	104
Male, 13 y	Embolisation of aorto-pulmonary shunts after lung bleeding	Left subclavian vein; inferior vena cava; left and right external iliac veins	19	No	67	55	135
Male, 13 y	Meningococcal sepsis	Left external iliac vein	10	No	73	27	101
Male, newborn	Open heart surgery	Right external iliac vein	15	No	52	55	68
Male, 3 mo	Open heart surgery	Right femoral artery	7	Yes	56	37	54
Male, newborn	Open heart surgery	Right femoral artery; right femoral vein; superior vena cava; right renal vein	9	No	78	29	43
Female, newborn	Open heart surgery	Right subclavian vein	16	No	60	60	58
Male, 3 mo	Abdominal surgery	Inferior vena cava; left femoral vein	45	No	77	43	57
Male, 7 mo	Open heart surgery	Left external iliac vein	5	Yes	73	43	26
Male, 17 mo	Open heart surgery	Right internal iugular vein	25	Yes	61	80	83
Female, 4 y	Open heart surgery	Left external iugular vein	8	No	70	93	38

Hep Exp indicates heparin exposure before diagnosis (days); Previous Hep, heparin administration during preceding 6 months; HPF4-AB, percentage of adult cutoff value of ELISA optical density.