title: Clinically suspected heparin-induced thrombocytopenia during extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  Patients receiving extracorporeal membrane oxygenation (ECMO) are at risk for thrombocytopenia including heparin-induced thrombocytopenia (HIT). The purpose of this study was to determine the frequency of suspected HIT in patients receiving ECMO and unfractionated heparin (UFH).
  
  
  METHODS
  We conducted a retrospective review in adult patients on ECMO. Patients were included if they received ECMO for at least 5 days and concomitant UFH.
  
  
  RESULTS
  There were 119 patients who met inclusion criteria. Twenty-three patients (19%) had a heparin-platelet factor 4 immunoassay performed. Patients with suspected HIT had a significantly lower platelet count within the first 3 days of ECMO, 69×10(9)/L (22-126×10(9)/L) vs 87.5×10(9)/L (63-149×10(9)/L); P=.04. The lowest platelet count on the day of HIT testing was 43×10(9)/L (26-73), representing a 71% reduction from baseline. Twenty patients (87%) had an optical density score less than 0.4, and all patients had a score less than 1.0. A functional assay was performed in 7 patients (30%), with only 1 patient having laboratory-confirmed HIT.
  
  
  CONCLUSIONS
  The evaluation of HIT occurred in a small percentage of patients, with HIT rarely being detected. Patients who had heparin-platelet factor 4 immunoassay testing exhibited lower platelet counts with a similar duration of ECMO and UFH exposure.
authors.affiliation: Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032. Electronic address: dglickk@gmail.com.
authors.forename: Daryl
authors.initials: D
authors.lastname: Glick
authors.affiliation: Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Dzierba
authors.affiliation: Department of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY 10032.
authors.forename: Darryl
authors.initials: D
authors.lastname: Abrams
authors.affiliation: Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032.
authors.forename: Justin
authors.initials: J
authors.lastname: Muir
authors.affiliation: Department of Hematology, Columbia University Medical Center, New York, NY 10032.
authors.forename: Andrew
authors.initials: A
authors.lastname: Eisenberger
authors.affiliation: Department of Hematology, Columbia University Medical Center, New York, NY 10032.
authors.forename: David
authors.initials: D
authors.lastname: Diuguid
authors.affiliation: Department of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210.
authors.forename: Erik
authors.initials: E
authors.lastname: Abel
authors.affiliation: Department of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY 10032.
authors.forename: Cara
authors.initials: C
authors.lastname: Agerstrand
authors.affiliation: Department of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY 10032.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
authors.affiliation: Department of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY 10032.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001777:Blood Coagulation; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000737:chemistry; D006760:Hospitalization; D006801:Humans; D007118:Immunoassay / Q000379:methods; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Blood; Circulatory temporary support; Coagulation/anticoagulation; Extracorporeal membrane oxygenation; Platelets