Annals of Hematology

, Volume 96, Issue 6, pp 1033–1036 | Cite as

Is low serum albumin level a significant predictor for the development of heparin-induced thrombocytopenia-thrombosis?

  • Fahad A. S. Al-Eidan
  • J. A. Al-Gramish
  • H. A. Al-Zamil
  • M. A. Crowther
Original Article
First Online:
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Accepted:

Abstract

The present study investigates the effect of albumin levels in patients who have developed heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia-thrombosis (HITT). A retrospective observational cohort study was conducted at King Abudlaziz Medical City (KAMC), a university teaching hospital, on patients diagnosed with HIT between June 2013 and December 2014. Clinical and laboratory findings were used to confirm HIT. Albumin levels were reported on admission as baseline and during HIT occurrence. Twenty-eight patients were identified as HIT positive by enzyme-linked immunosorbent assay (ELISA), with a cutoff value of ≥1 optical density units and pretest probability “4Ts” score of ≥4. Of the 28 patients, nine (32%) developed HITT. Demographic characteristics of the patients who developed HIT and HITT were similar. The mean albumin level for patients who developed HITT was significantly lower than that for patients who developed HIT (p < 0.001). Our findings suggest that patients with low serum albumin levels are at greater risk of developing HITT. This finding awaits confirmation in larger prospective clinical trials.

Keywords

Adverse drug reactions Risk factors Serum albumin Thrombocytopenia Thrombosis 
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Notes

Authors’ contributions

F.A.S. Al-Eidan designed and initiated the study, analyzed the data, and drafted the manuscript. J. A. Al-Gramish and H. A. Al-Zamil contributed to the collection and interpretation of the data and revised the manuscript. M. Crowther involved in the study design, interpretation of the data and critically revised the manuscript. All authors approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S, Crowther M (2012) Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(Suppl):e495S–e530SCrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Al-Eidan FA (2015) Pharmacotherapy of heparin-induced thrombocytopenia: therapeutic options and challenges in the clinical practices. J Vasc Nurs 33:10–20CrossRefPubMedGoogle Scholar
  3. 3.
    Francis JL, Palmer GJ III, Moroose R, Drexler A (2003) A comparison of bovine and porcine heparin in heparin antibody formation after cardiac surgery. Ann Thorac Surg 75:17–22CrossRefPubMedGoogle Scholar
  4. 4.
    Greinacher A, Farner B, Kroll H, Kohlmann T, Warkentin TE, Eichler P (2005) Clinical features of heparin-induced thrombocytopenia including risk factors for thrombosis: a retrospective analysis of 408 patients. Thromb Haemost 94:132–135PubMedGoogle Scholar
  5. 5.
    Al-Eidan FA (2015) Is the incidence trend of heparin-induced thrombocytopenia decreased by the increased use of low-molecular-weight-heparin? Mediterr J Hematol Infect Dis 7:e2015029CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Cuker A (2014) Clinical and laboratory diagnosis of heparin-induced thrombocytopenia: an integrated approach. Semin Thromb Hemost 40:106–114PubMedGoogle Scholar
  7. 7.
    ASSERACHROM® HPIA package insert (2011) Diagnostica Stago S.A.S, Asniere sur Seine, FranceGoogle Scholar
  8. 8.
    Ritchie BM, Connors JM, Sylvester KW (2015) Comparison of an IgG-specific enzyme-linked immunosorbent assay cutoff of 0.4 versus 0.8 and 1.0 optical density units for heparin-induced thrombocytopenia. Clin Appl Thromb Hemost. doi: 10.1177/1076029615606532
  9. 9.
    Zwicker JI, Uhl L, Huang WY, Shaz BH, Bauer KA (2004) Thrombosis and ELISA optical density values in hospitalized patients with heparin-induced thrombocytopenia. J Thromb Haemost 2:2133–2137CrossRefPubMedGoogle Scholar
  10. 10.
    Baroletti S, Hurwitz S, Conti NA, Fanikos J, Piazza G, Goldhaber SZ (2012) Thrombosis in suspected heparin-induced thrombocytopenia occurs more often with high antibody levels. Am J Med 125:44–49CrossRefPubMedGoogle Scholar
  11. 11.
    Janatpour KA, Gosselin RC, Dager WE, Lee A, Owings JT, Zhou J, Wun T (2007) Usefulness of optical density values from heparin-platelet factor 4 anti-body testing and probability scoring models to diagnose heparin-induced thrombocytopenia. Am J Clin Pathol 127:429–433CrossRefPubMedGoogle Scholar
  12. 12.
    Kelton JG, Arnold DA, Bates SM (2013) Nonheparin anticoagulants for heparin-induced thrombocytopenia. N Engl J Med 368:737–744CrossRefPubMedGoogle Scholar
  13. 13.
    Mahmoodi BK, Gansevoort RT, Veeger NJ, Matthews AG, Navis G, Hillege HL, van der Meer J (2009) Prevention of Renal and Vascular End-stage Disease (PREVEND) Study Group. Microalbuminuria and risk of venous thromboembolism. JAMA 301:1790–1797CrossRefPubMedGoogle Scholar
  14. 14.
    Folsom AR, Lutsey PL, Heckbert SR, Cushman M (2010) Serum albumin and risk of venous thromboembolism. Thromb Haemost 104:100–104CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kumar S, Chapagain A, Nitsch D, Yaqoob MM (2012) Proteinuria and hypoalbuminemia are risk factors for thromboembolic events in patients with idiopathic membranous nephropathy: an observational study. BMC Nephrol 13:107CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Singhal R, Brimble KS (2006) Thromboembolic complications in the nephrotic syndrome: pathophysiology and clinical management. Thromb Res 118:397–407CrossRefPubMedGoogle Scholar
  17. 17.
    Vaziri ND, Paule P, Toohey J, Hung E, Alikhani S, Darwish R, Pahl MV (1984) Acquired deficiency and urinary excretion of antithrombin III in nephrotic syndrome. Arch Intern Med 144:1802–1803CrossRefPubMedGoogle Scholar
  18. 18.
    Elidrissy ATH, Gader AMA (1985) Antithrombin III (ATIII) and fibrinogen levels in nephrotic syndrome in children. Haemostasis 15:384–388PubMedGoogle Scholar
  19. 19.
    Kauffmann RH, Veltkamp JJ, van Tilburg N (1978) Acquired antithrombin III deficiency and thrombosis in the nephrotic syndrome. Am J Med 65:607–610CrossRefPubMedGoogle Scholar
  20. 20.
    Lau SO, Tkachuck JY, Hasegawa DK, Edson JR (1980) Plasminogen and antithrombin III deficiencies in the childhood nephrotic syndrome associated with plasminogenuria and antithrombinuria. J Pediatr 96:390–392CrossRefPubMedGoogle Scholar
  21. 21.
    de Sain-van der Velden MG, Kaysen GA, de Meer K, Stellaard F, Voorbij HA, Reijngoud DJ, Rabelink TJ, Koomans HA (1998) Proportionate increase of fibrinogen and albumin synthesis in nephrotic patients: measurements with stable isotopes. Kidney Int 53:181–188CrossRefPubMedGoogle Scholar
  22. 22.
    Machleidt C, Mettang T, Starz E, Weber J, Risler T, Kuhlmann U (1989) Multifactorial genesis of enhanced platelet aggregability in patients with nephrotic syndrome. Kidney Int 36:1119–1124CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Fahad A. S. Al-Eidan
    • 1
    • 2
  • J. A. Al-Gramish
    • 2
    • 3
  • H. A. Al-Zamil
    • 1
    • 4
  • M. A. Crowther
    • 5
  1. 1.College of MedicineKing Saud bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
  2. 2.Department of Pharmaceutical CareKing Abdulaziz Medical CityRiyadhSaudi Arabia
  3. 3.College of PharmacyKing Saud bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
  4. 4.Department of SurgeryKing Abdulaziz Medical CityRiyadhSaudi Arabia
  5. 5.Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonCanada

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