Heparin-induced thrombocytopenia: A complication in extracorporeal photochemotherapy (photopheresis)∗

Dittberner, Thomas; Schöttler, Elke; Ranze, Oliver; Greinacher, Andreas; Knobler, Robert

doi:10.1067/mjd.2002.120598

Cited by 8 publications

(6 citation statements)

References 6 publications

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“…A decrease in platelet count may occur as a consequence of heparin-induced thrombocytopenia. Anemia has been observed in long-term ECP patients, after incomplete reinfusion, or, rarely, because of hemolysis 6,38–41 . With regard to safety, efficacy, and practicability, however, the role of ECP must be put into perspectives given the availability of novel highly effective and safe treatment modalities.…”

Section: Discussionmentioning

confidence: 99%

“…Anemia has been observed in long-term ECP patients, after incomplete reinfusion, or, rarely, because of hemolysis. 6,[38][39][40][41] With regard to safety, efficacy, and practicability, however, the role of ECP must be put into perspectives given the availability of novel highly effective and safe treatment modalities. A better understanding of the relevant pathomechanisms in AD has resulted in the development of novel treatment regimens for this condition.…”

Section: Table 2 Changes Inmentioning

confidence: 99%

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Impact of Extracorporeal Photopheresis on Blood Parameters of Atopic Dermatitis Patients

et al. 2022

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BackgroundExtracorporeal photopheresis (ECP) is a safe treatment modality with immunomodulatory effects. The latter may also explain efficacy of ECP in patients with atopic dermatitis (AD).ObjectiveWe aimed to assess various blood parameters of AD patients who underwent ECP over a maximum 1-year treatment period.MethodsWe performed a retrospective single-center chart review (clinical data, laboratory data) of adult patients with AD who had received for at least 3 ECP cycles, in part combined with other treatment modalities.ResultsWe studied 60 patients with AD (85% extrinsic type, 15% intrinsic type) who had median number of 14 (4–23) ECP cycles within a maximum 1-year treatment. When compared with baseline, leukocytes and lymphocytes remained significantly decreased after 3-, 6-, 9-, and 12-month ECP (P = 0.014 and P = 0.0012, respectively). A significant decline of eosinophils, as well as eosinophilic cationic protein levels, was observed after 3-, 6-, 9-, and 12-month ECPs (P = 0.011 and P = 0.0017, respectively). Total serum immunoglobulin E (IgE), as well as lactate dehydrogenase, were significantly decreased at 3-, 6-, 9-, and 12-month evaluation compared with baseline (P < 0.00001 and P = 0.00007, respectively). Patients with slight or marked improvement of AD after their ECP treatment period had significantly higher median baseline serum IgE levels than patients who did not respond to ECP (P = 0.0023).ConclusionsSeveral laboratory parameters, including eosinophils, eosinophilic cationic protein, total serum IgE, and lactate dehydrogenase, which declined under ECP, are well-known disease biomarkers for AD patients. With normalization of the abovementioned laboratory parameters, a clinical response to ECP treatment was observed in almost two thirds of patients, confirming that ECP may be an effective combination treatment modality for AD.

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Section: Discussionmentioning

confidence: 99%

Section: Table 2 Changes Inmentioning

confidence: 99%

Impact of Extracorporeal Photopheresis on Blood Parameters of Atopic Dermatitis Patients

et al. 2022

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“…A decrease in platelet count may occur as a consequence of heparininduced thrombocytopenia. 13 Anemia has been observed in long-term ECP patients, after incomplete reinfusion, or, rarely, due to hemolysis. In 56% of patients studied, IDA could be detected over time.…”

Section: Discussionmentioning

confidence: 99%

“…Acute AEs observed in ECP‐treated patients are generally transient and mild, and may include hypotension, headache, chills, and hematoma/localized infection at the site of venipuncture. A decrease in platelet count may occur as a consequence of heparin‐induced thrombocytopenia 13 . Anemia has been observed in long‐term ECP patients, after incomplete reinfusion, or, rarely, due to hemolysis 7–12 .…”

Section: Discussionmentioning

confidence: 99%

Impact of extracorporeal photopheresis on blood and coagulation parameters

Gambichler

Chatzipantazi

Stranzenbach

et al. 2022

Dermatologic Therapy

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Extracorporeal photopheresis (ECP) is considered a safe treatment modality. We aimed to assess blood parameters including coagulation during ECP over time. We performed a long‐term retrospective single‐center chart review (laboratory parameters) of adult patients (n = 172) who had received ECP for any indication. We observed a significant decrease (p < 0.05) in erythrocytes, hemoglobin, and leukocytes compared to baseline levels after only one ECP procedure. This decrease persisted after 3‐, 6‐, 9‐, and 12‐months of ECP. A significant pathological decline of hemoglobin was observed in a higher proportion (26.4% and 25.2%, respectively) of patients after 6 (p = 0.0007) and 12 (p = 0.012) months of ECP. Mean corpuscular volume as well as hematocrit was significantly decreased at 3‐, 6‐, 9‐, and 12‐months of evaluation compared to baseline (p < 0.05). After 9 and 12 months of ECP we observed a further decline in lymphocyte counts (p < 0.05). Various coagulation parameters did not change significantly during ECP treatment. Even though not all alterations observed in peripheral blood of ECP patients in the present study were of clinical significance, risk for developing persistent anemia must be considered in patients undergoing ECP.

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“…The most severe adverse effects of heparin are bleeding [ 23 ] and the less common but equally feared heparin-induced thrombocytopenia (HIT) [ 24 ]. The prevalence of HIT due to procedural heparin anticoagulation during apheresis is not known, and data are limited to case reports [ 25 ]. Following this, an alternative strategy for large-volume IA with heparin anticoagulation in selected patients was developed and established at our center in 2013.…”

Section: Introductionmentioning

confidence: 99%

Safety and Feasibility of Immunoadsorption with Heparin Anticoagulation in Preparation of ABO-Incompatible Kidney Transplantation: A Retrospective Single-Center Study

Junker

Volken

Stehle

et al. 2023

Transfus Med Hemother

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Introduction: Immunoadsorption (IA) of isohemagglutinins is an often-crucial procedure in preparation of major ABO blood group-incompatible living donor kidney transplantation (ABOi LDKT). Standard citrate-based anticoagulation during the procedure has potential disadvantages for distinct patient groups. In this study, we report our experience with an alternative anticoagulation scheme using heparin during IA for selected patients. Methods: We conducted a retrospective analysis of all patients who underwent IA with heparin anticoagulation between February 2013 and December 2019 at our institution with focus on the safety and efficacy of the adapted procedure. For further validation, we compared graft function, graft survival, and overall survival with those of all recipients of living donor kidney transplants with or without pretransplant desensitizing apheresis for ABO antibodies at our institution during the same period. Results: In thirteen consecutive patients prepared for ABOi LDKT with IA with heparin anticoagulation, no major bleeding or other significant complications were observed. All patients achieved sufficient isohemagglutinin titer reduction to proceed to transplant surgery. Graft function, graft survival, and overall survival did not significantly differ from patients treated with standard anticoagulation for IA or ABO compatible recipients of living donor kidneys. Conclusion: IA with heparin in preparation of ABOi LDKT is safe and feasible for selected patients after internal validation.

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Heparin-induced thrombocytopenia: A complication in extracorporeal photochemotherapy (photopheresis)∗

Cited by 8 publications

References 6 publications

Impact of Extracorporeal Photopheresis on Blood Parameters of Atopic Dermatitis Patients

Impact of Extracorporeal Photopheresis on Blood Parameters of Atopic Dermatitis Patients

Impact of extracorporeal photopheresis on blood and coagulation parameters

Safety and Feasibility of Immunoadsorption with Heparin Anticoagulation in Preparation of ABO-Incompatible Kidney Transplantation: A Retrospective Single-Center Study

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