SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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L Risch1 , JE Fischer2 , R Herklotz3 , A.R. Huber3

1Clinical Decision Making Research Unit, Vorarlberg Institute of Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria, 2University-Children´s Hospital, Department of Neonatology and Pediatric Intensive Care, Zurich, Switzerland, 3Department of Laboratory Medicine, Kantonsspital, Aarau, Switzerland

Objective: Reports on HIT, an adverse drug reaction characterized by a strong hypercoagulable state despite thrombocytopenia, in pediatric patients are confined to isolated case reports. As children-specific physiology could alter the picture of HIT in pediatrics (e.g. high thrombopoietic capacity of bone marrow, lower antibody production in infants and neonates) the objective was to systematically combine the published data in order to define the diagnostic characteristics of HIT in children.
Methods: Cases were identified by MEDLINE-search and review of bibliographies. We collected patient demographics as well as clinical and laboratory characteristics.
Results: Reports on 70 patients could be retrieved, all of whom had UFH as the trigger of HIT. Most patients had a typical-onset pattern of HIT (i.e.>= 5 days of UFH), although some had rapid-onset-HIT (i.e. on the first day of UFH in patients with UFH during the recent 100 days). The median platelet count nadir was 54 x 109/L (range 7- 352 x 109/L), 11% of the reported patients had nadirs >150x109/L. The cumulative sensitivity of confirmatory HIT antibody testing was 88% with functional assays, and 86% with ELISA. 8 very young children with clinical evidence of HIT had ELISA titers significantly higher than matched controls, but still in the normal range. However, HIT could be successfully confirmed in 16 neonates by functional assays using adult cut-off criteria. Measuring aPTT by a POCT device was not suited to reflect the anticoagulant effect of lepirudin.
Conclusions: HIT in children can occur in a rapid and typical-onset pattern. A normal platelet count does not exclude HIT. Serial platelet count determinations are thus important to detect relative thrombocytopenia (i.e.platelet count fall >50%). Antibody testing in neonates suspected to suffer from HIT should be done with both functional and antigenic assays. Finally, centralized laboratory testing allows for accurate monitoring of anticoagulation therapy.

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