Heparin-induced thrombocytopenia in pediatrics

As in adult patients, heparin is used for prophylaxis and treatment of thro mboembolism in newborns, children, and adolescents. Patients receiving hepa rin are potentially at risk to develop heparin-induced thrombocytopenia (HI T). HIT type II has been extensively described in the adult population; onl y a few reports address HIT type II in pediatric patients (total of 15 neon ates, 4 young children, 12 older children and adolescents). The available d ata are discussed, and the case of a patient with recurrent thrombosis and HIT type II without thrombocytopenia is presented. The review of the Litera ture reveals that HIT type II occurs especially in neonates and adolescents , corresponding to the two age peaks of thrombosis in pediatric patients. R isk factors for thrombosis include hereditary factors, immobilization, and surgery. HIT complications are severe and partly lead to life-threatening t hromboembolism. In three patients, an increasing heparin demand was found. In five cases, thrombocytopenia was absent. Heparin was replaced mostly by danaparoid sodium; in three patients hirudin was used as an alternative ant icoagulant. HIT type II represents a potentially dangerous complication of heparin therapy in pediatric patients and should be taken into consideratio n whenever heparin is given for prophylactic or therapeutic use in newborns , children, or adolescents.