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Monatsschrift Kinderheilkunde

, Volume 151, Issue 11, pp 1180–1187 | Cite as

Heparininduzierte Thrombozytopenie in der Pädiatrie und ihre Therapiealternativen

Fallbericht und Literaturübersicht
  • A. F. Klenner
  • C. Fusch
  • V. Varnholt
  • H. Ringe
  • O. Meyer
  • B. Stiller
  • A. GreinacherEmail author
Originalien

Zusammenfassung

Hintergrund.

Die immunologische Form der heparininduzierten Thrombozytopenie (HIT) ist eine schwere Komplikation einer Heparintherapie. Sie ist durch IgG-Antikörper gegen multimolekulare Komplexe aus Plättchenfaktor 4 (PF4) und Heparin verursacht. Diese binden über Fcγ-Rezeptoren an Thrombozyten; die Vernetzung von Fcγ-Rezeptoren bewirkt eine Thrombozytenaktivierung, Plättchenaggregation und erhöhte Thrombinbildung. Dies begünstigt die Ausbildung neuer thrombembolischer Komplikationen unter Heparin. Für pädiatrische Patienten gibt es nur wenige Daten zur HIT. Wir beschreiben einen neuen eigenen Fall bei einem Neugeborenen und analysieren Literaturberichte von 51 Kindern.

Kasuistiken.

Bei den Neugeborenen und Kleinkindern trat die HIT in der Mehrzahl der Fälle nach Herzoperationen auf. Die älteren Kinder entwickelten die HIT v. a. während einer Heparinisierung wegen vorangegangener thrombembolischer Komplikationen. Bei 2 Kindern wurde die HIT durch Heparin zum Offenhalten intravaskulärer Katheter induziert. Bei allen Kindern trat die HIT unter einer Therapie mit unfraktioniertem Heparin auf. Nach Sicherung der Diagnose HIT wurde Heparin abgesetzt, und die Antikoagulation wurde mit Aspirin, Warfarin, Danaparoid, Lepirudin oder niedermolekularem Heparin weitergeführt. Die meisten Kinder überlebten die HIT, 5 Neugeborene und ein 4-jähriges Mädchen verstarben, wahrscheinlich an ihrer schweren Grunderkrankung.

Schlussfolgerung.

Ähnlich wie bei Erwachsenen könnte die Inzidenz der HIT bei Kindern wahrscheinlich durch die Verwendung von niedermolekularem Heparin anstelle des unfraktionierten Heparins gesenkt werden.

Schlüsselwörter

Heparininduzierte Thrombozytopenie Heparin Thrombose Lepirudin Neugeborene 

Abstract

Background.

The immun-mediated type of heparin-induced thrombocytopenia (HIT) is a severe complication of heparin therapy. HIT is caused by antibodies of IgG class against multimolecular complexes consisting of platelet factor 4 (PF4) and heparin. These antibodies crosslink platelet Fcγ-receptors resulting in platelet activation, platelet aggregation, and thrombin generation. This can lead to new thromboembolic complications during heparin therapy.

Case reports.

We report a new case of HIT in a newborn and summarize the 51 cases reported in the literature. This analysis shows, newborns and small children develop HIT mostly after heart surgery. In older children, HIT mainly occurs during heparinization due to spontaneous thromboembolic complications. In two children, HIT was induced by heparin for prolonging catheter patency. In all cases, HIT occurred during therapy with unfractionated heparin. After diagnosis of HIT anticoagulation was continued with aspirin, warfarin, danaparoid, lepirudin, or low-molecular-weight heparin. Most children survived HIT, five newborns and one 4-year-old girl died, most likely because of the severity of the underlying disease.

Conclusion.

Similar to adults, incidence of HIT might be reduced when low-molecular-weight heparins are used instead of unfractionated heparin.

Keywords

Heparin-induced thrombocytopenia Heparin Thrombosis Lepirudin Newborns 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • A. F. Klenner
    • 1
  • C. Fusch
    • 2
  • V. Varnholt
    • 3
  • H. Ringe
    • 3
  • O. Meyer
    • 4
  • B. Stiller
    • 5
  • A. Greinacher
    • 1
    • 6
    Email author
  1. 1.Abteilung Transfusionsmedizin, Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität Greifswald
  2. 2.Abteilung Neonatologie und Pädiatrische Intensivmedizin, Klinik für Kindermedizin, Ernst-Moritz-Arndt-Universität Greifswald
  3. 3.Klinik für Allgemeine Pädiatrie der Charité, Campus Virchow-Klinikum, Humboldt-Universität zu Berlin
  4. 4.Institut für Transfusionsmedizin der Charité, Campus Virchow-Klinikum, Humboldt-Universität zu Berlin
  5. 5.Klinik für angeborene Herzfehler/Kinderkardiologie, Deutsches Herzzentrum Berlin
  6. 6.Abteilung Transfusionsmedizin, Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität Greifswald, Sauerbruchstraße, 17487 Greifswald

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