Clinical analysis of critically ill children with heparin-induced thrombocytopenia during extracorporeal membrane oxygenation
10.3760/cma.j.issn.1673-4912.2022.11.003
- VernacularTitle:危重症儿童体外膜肺氧合期间并发肝素诱导的血小板减少症临床分析
- Author:
Shuyan GAN
1
;
Meixiu LIU
;
Saihu HUANG
;
Gangfeng YAN
;
Xiaodi CAI
;
Weiming CHEN
;
Guoping LU
Author Information
1. 国家儿童医学中心 复旦大学附属儿科医院重症医学科，上海 201102
- Keywords:
Extracorporeal membrane oxygenation;
Heparin-induced thrombocytopenia;
Children;
Clinical features;
Thrombosis
- From:
Chinese Pediatric Emergency Medicine
2022;29(11):863-867
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To prospectively investigate the prevalence of heparin-induced thrombocytopenia (HIT) in critically ill children during extracorporeal membrane oxygenation(ECMO) and explore the clinical characteristics and prognosis of HIT during ECMO.Methods:A total of 22 critically ill children, who had received ECMO support for more than 96 hours in the Intensive Care Unit at the Children′s Hospital of Fudan University from March 2019 to December 2020, were enrolled.According to the 4T score and the heparin/platelet factor 4(PF4) antibody, children whose 4T scores were not less than 6 and heparin/ PF4 antibodies were positive, were classified into HIT group ( n=6), and non-HIT group ( n=16). The clinical outcomes and the incidence of thrombotic events were compared between two groups. Results:The incidence of HIT during ECMO in critically ill children was 27% in this study.The incidence of thrombosis in the ECMO circuit in the HIT group was higher (100% vs.63%, P=0.133), and the average time to the first thrombosis in ECMO circuit in the HIT group was shorter than that in the non-HIT group (3.70 d vs.5.44 d, P=0.06). During the first 14 days of ECMO, the proportion of children with thrombotic events no less than twice was higher in the HIT group (67% vs.19%, P=0.054). There was no significant difference regarding the survival rate at 28 days after ECMO withdrawal between two groups (33% vs.50%, P=0.664). Conclusion:The prevalence of HIT during ECMO in critically ill children is high.Thrombosis events tend to occur earlier and more extensively in children with HIT during ECMO.No significant effect of HIT on the survival rate of children during ECMO is found.Whether HIT has effect on the survival rate of children with ECMO requires a prospective and large clinical study.
