Post‐transfusion Purpura vs. Heparin‐induced Thrombocytopenia: Differential Diagnosis in Clinical Practice

Araújo, Francisco; Sa, Johnson; Araújo, Valéria Martins de; Lopes, Monique Kelly Duarte; Cunha‐Ribeiro, L. M.

doi:10.1046/j.1365-3148.2000.00269-4.x

Cited by 10 publications

(6 citation statements)

References 10 publications

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“…within 2 weeks) in this particular situation. However, the clinical manifestations are usually different in PTP (with severe bleeding and very low PC, features which are unusual in HIT) and biological assays, especially SRA, are very important to distinguish between these two disorders (Araujo et al , 2000; Lubenow et al , 2000). Between January 2000 and December 2003, 1678 patients underwent cardiac surgery with CPB in our institution and 1502 received LMWH in the following 10 d while 176 were treated by UFH.…”

Section: Discussionmentioning

confidence: 99%

Changes in platelet count after cardiac surgery can effectively predict the development of pathogenic heparin‐dependent antibodies

Pouplard¹,

et al. 2005

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Summary Cardiopulmonary bypass (CPB) induces the release of platelet factor 4 (PF4) and patients are at risk of heparin‐induced thrombocytopenia (HIT). This study was aimed to determine whether an abnormal evolution in platelet count (PC) after CPB is predictive of the development of HIT antibodies. Two abnormal PC patterns were defined: pattern P1, characterized by a decrease in PC following previous correction of thrombocytopenia occurring during CPB, and pattern P2, defined as a persistent low PC in the days following CPB. PC was evaluated for 10 d in 305 consecutive patients before and after CPB. Serotonin release assay (SRA) was carried out between days 8 and 10 to detect pathogenic heparin‐dependent antibodies. Moreover, antibodies to heparin–PF4 (H–PF4) complexes were assayed by enzyme‐linked immunosorbent assay. PC evolution after CPB was normal in 300 patients although antibodies to H–PF4 were frequently present (53·4%). Changes in PC were abnormal in five patients with pattern P1 (n = 4) or P2 (n = 1). As SRA was positive in four of the five cases, the positive predictive value of abnormal PC pattern for pathogenic HIT antibodies was 80%. Careful follow‐up of PC after CPB makes it possible to predict with high specificity (99%) for those patients who develop pathogenic HIT antibodies.

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Section: Discussionmentioning

confidence: 99%

Changes in platelet count after cardiac surgery can effectively predict the development of pathogenic heparin‐dependent antibodies

Pouplard¹,

et al. 2005

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“…Another complex situation is the patient receiving both heparin and PLTs, and this series includes two cases where both HPA and heparin‐dependent PLT antibodies were found. These are important conditions to differentiate by appropriate investigation 29 because PLT transfusion is contraindicated in heparin‐induced thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

The impact of universal leukodepletion of the blood supply on hemovigilance reports of posttransfusion purpura and transfusion‐associated graft‐versus‐host disease

Williamson

Stainsby²,

Jones³

et al. 2007

Transfusion

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“…The differential diagnosis between post-transfusion purpura and heparin-induced thrombocytopenia (HIT) should, therefore, be taken into account although it can be difficult in the early stages. [9][10] The thrombocytopenia observed in PTP is usually more severe than in HIT but there have been reports in the literature of an HIT misdiagnosis, resulting in delayed diagnosis and treatment with lethal consequences. 9 However, HIT can be associated with PTP.…”

Section: Clinical Presentationmentioning

confidence: 99%