Paper_ Outcomes of Platelet Transfusion in Heparin Induced Thrombocytopenia Patients
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4/14/2014 Paper: Outcomes Of Platelet Transfusion In Heparin Induced Thrombocytopenia Patients https://ash.confex.com/ash/2013/webprogram/Paper57517.html 1/2 Start/Search Browse by Day Browse by Program Browse by Author Browse by Keyword Personal Scheduler ASH Meeting Home ASH Home Author name in bold denotes the presenting author Asterisk * with author name denotes a NonASH member denotes an abstract that is clinically relevant. denotes that this is a recommended PHD Trainee Session. denotes that this is a ticketed session. 2311 Outcomes Of Platelet Transfusion In Heparin Induced Thrombocytopenia Patients Program: Oral and Poster Abstracts Session: 311. Disorders of Platelet Number or Function: Poster II Sunday, December 8, 2013, 6:30 PM8:30 PM Hall E (Ernest N. Morial Convention Center) Rohit Kumar 1* , Rohtesh S. Mehta, MD, MPH, MS 1 , Amy Zhou, MD 2 and Roy E. Smith, MD 3 1 UPMC, Pittsburgh, PA 2 Washington University, St Lois, MO 3 Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA Introduction: Heparin induced thrombocytopenia (HIT) is an immune mediated adverse reaction to heparin characterized by thrombosis and thrombocytopenia. Current guidelines recommend against the transfusion of platelets in patients with HIT based on a small number of reports suggesting adverse neurologic outcomes or mortality within hours of platelet transfusion. A more recent study, however, described no adverse outcomes in patients with HIT who received platelet transfusion. Currently, there is a paucity of literature and ambiguity in regards to the safety of platelet transfusion for patients with HIT. To analyze our experience in these situations, we examined the outcomes of patients who received platelet transfusions during the admission for HIT to our institution, which is a large tertiary care referral center. Methods: We reviewed records of patients admitted with a diagnosis of HIT from 9/2002 to 9/2012. The inclusion criteria included (1a) positive serotonin release assay (SRA), defined as >20% release, or (1b) intermediate/high “4T risk score” and HPF4 optical density (OD) > 0.4, if SRA was not available and (2) platelet transfusion within 30 days of HIT diagnosis. Any adverse outcome, such as death, myocardial infarction, stroke, DVT/PE, worsened thrombocytopenia, or bleeding that occurred within 24 hours of the transfusion was recorded, along with indication for transfusion and increment in platelet count posttransfusion. A minimum increase in platelet count of 10,000/μL was considered adequate. Patients’ demographic characteristics, active malignancy, history of thromboembolic event, CVA or CAD within past 30 days of admission were also recorded. Results: In our analysis of 1720 patients, 24 met the inclusion criteria, who received a total of 42 transfusions. We did not find any adverse outcomes within 24 hours of platelet transfusion. A 66yearold female developed right parietal infarct 36 hours after transfusion, which was deemed unrelated. Of note, she had a past medical history of hypertension, diabetes mellitus II, hyperlipidemia and deep venous thrombosis. Three patients (12.5%) died during the admission, two of which were due to sepsis and one due to advanced malignancy. The most common reason for transfusion was empiric either (a) prior to an invasive procedure/surgery in 52.4% (22/42) (median platelet count 52,000/μL, range 15,000151,000/μL), or (b) due to “low count” in 28.6% (12/42) (median count 18,000/μL, range 7,00031,000/μL), followed by (c) therapeutic due to bleeding in 14.3% (6/42) (median platelet count 52,500/μL, range 27,000219,000/μL). The median time to platelet transfusion was 7 days (range <1 to 22 days) from the time of diagnosis. Median increment in platelet count was 27,500/μL (range 4,000112,000/μL); one transfusion did not result in adequate increment while 10 had missing information. Adequate hemostasis was achieved in 50% (3/6) transfusions given due to bleeding. A total of 52 packs of pooled platelets were transfused. Conclusions: None of the patients had any adverse event related to platelet transfusion. One patient had a thrombotic event 36 hours post transfusion. Our data does not suggest against platelet transfusions in patients with HIT, if clinically indicated. Patients diagnosed with HIT(n=24) Intermediate 4T score (n=13) High 4T score (n=11) HIT related thrombosis prior to transfusion Myocardial Infarction Venous thromboembolism Adequate platelet increment Deaths 2 0 2 11 2 8 1 7 10 1 Disclosures: No relevant conflicts of interest to declare. See more of: 311. Disorders of Platelet Number or Function: Poster II See more of: Oral and Poster Abstracts << Previous Abstract | Next Abstract >> * signifies nonmember of ASH American Society of Hematology 2021 L Street NW, Suite 900, Washington, DC 20036 | Phone 2027760544 | Fax 2027760545
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Transcript of Paper_ Outcomes of Platelet Transfusion in Heparin Induced Thrombocytopenia Patients
4/14/2014 Paper: Outcomes Of Platelet Transfusion In Heparin Induced Thrombocytopenia Patients
https://ash.confex.com/ash/2013/webprogram/Paper57517.html 1/2
Start/Search
Browse by Day
Browse by Program
Browse by Author
Browse by Keyword
Personal Scheduler
ASH Meeting Home
ASH Home
Author name in bold denotes thepresenting author
Asterisk * with author name denotesa NonASH member
denotes an abstract that isclinically relevant.
denotes that this is arecommended PHD Trainee Session.
denotes that this is a ticketedsession.
2311 Outcomes Of Platelet Transfusion In Heparin InducedThrombocytopenia Patients
Program: Oral and Poster AbstractsSession: 311. Disorders of Platelet Number or Function: Poster II
Sunday, December 8, 2013, 6:30 PM8:30 PMHall E (Ernest N. Morial Convention Center)
Rohit Kumar1*, Rohtesh S. Mehta, MD, MPH, MS1, Amy Zhou, MD2 and Roy E. Smith, MD3
1UPMC, Pittsburgh, PA2Washington University, St Lois, MO3Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
Introduction: Heparin induced thrombocytopenia (HIT) is an immune mediated adverse reaction to heparincharacterized by thrombosis and thrombocytopenia. Current guidelines recommend against the transfusion of plateletsin patients with HIT based on a small number of reports suggesting adverse neurologic outcomes or mortality withinhours of platelet transfusion. A more recent study, however, described no adverse outcomes in patients with HIT whoreceived platelet transfusion.
Currently, there is a paucity of literature and ambiguity in regards to the safety of platelet transfusion for patients withHIT. To analyze our experience in these situations, we examined the outcomes of patients who received platelettransfusions during the admission for HIT to our institution, which is a large tertiary care referral center.
Methods: We reviewed records of patients admitted with a diagnosis of HIT from 9/2002 to 9/2012. The inclusioncriteria included (1a) positive serotonin release assay (SRA), defined as >20% release, or (1b) intermediate/high “4Trisk score” and HPF4 optical density (OD) > 0.4, if SRA was not available and (2) platelet transfusion within 30 days ofHIT diagnosis. Any adverse outcome, such as death, myocardial infarction, stroke, DVT/PE, worsenedthrombocytopenia, or bleeding that occurred within 24 hours of the transfusion was recorded, along with indication fortransfusion and increment in platelet count posttransfusion. A minimum increase in platelet count of 10,000/μL wasconsidered adequate. Patients’ demographic characteristics, active malignancy, history of thromboembolic event, CVAor CAD within past 30 days of admission were also recorded.
Results: In our analysis of 1720 patients, 24 met the inclusion criteria, who received a total of 42 transfusions. We didnot find any adverse outcomes within 24 hours of platelet transfusion. A 66yearold female developed right parietalinfarct 36 hours after transfusion, which was deemed unrelated. Of note, she had a past medical history ofhypertension, diabetes mellitus II, hyperlipidemia and deep venous thrombosis. Three patients (12.5%) died during theadmission, two of which were due to sepsis and one due to advanced malignancy. The most common reason fortransfusion was empiric either (a) prior to an invasive procedure/surgery in 52.4% (22/42) (median platelet count52,000/μL, range 15,000151,000/μL), or (b) due to “low count” in 28.6% (12/42) (median count 18,000/μL, range7,00031,000/μL), followed by (c) therapeutic due to bleeding in 14.3% (6/42) (median platelet count 52,500/μL,range 27,000219,000/μL). The median time to platelet transfusion was 7 days (range <1 to 22 days) from the time ofdiagnosis. Median increment in platelet count was 27,500/μL (range 4,000112,000/μL); one transfusion did not resultin adequate increment while 10 had missing information. Adequate hemostasis was achieved in 50% (3/6) transfusionsgiven due to bleeding. A total of 52 packs of pooled platelets were transfused.
Conclusions: None of the patients had any adverse event related to platelet transfusion. One patient had a thromboticevent 36 hours post transfusion. Our data does not suggest against platelet transfusions in patients with HIT, if clinicallyindicated. Patients diagnosed with
HIT(n=24) Intermediate 4T
score (n=13)High 4T score
(n=11)HIT related thrombosis prior totransfusion
Myocardial InfarctionVenous thromboembolism
Adequate platelet increment
Deaths
2
0
2
11
2
8
1
7
10
1
Disclosures: No relevant conflicts of interest to declare.
See more of: 311. Disorders of Platelet Number or Function: Poster IISee more of: Oral and Poster Abstracts
<< Previous Abstract | Next Abstract >>
*signifies nonmember of ASH
American Society of Hematology2021 L Street NW, Suite 900, Washington, DC 20036 | Phone 2027760544 |Fax 2027760545
4/14/2014 Paper: Outcomes Of Platelet Transfusion In Heparin Induced Thrombocytopenia Patients
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