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Frequency and Clinical Impact of Platelet Factor 4-Specific Antibodies in Patients Undergoing Extracorporeal Membrane Oxygenation
- Source :
- Thrombosis and Haemostasis. 119:1138-1146
- Publication Year :
- 2019
- Publisher :
- Georg Thieme Verlag KG, 2019.
-
Abstract
- Introduction/Objectives Extracorporeal membrane oxygenation (ECMO) provides circulatory support in patients with severe heart failure, but the frequent use of unfractionated heparin exposes patients to high risk of heparin-induced thrombocytopenia (HIT). We prospectively evaluated the development and clinical impact of platelet factor 4 (PF4)-specific antibodies (Abs) during ECMO and whether specific biological characteristics could predict HIT. Materials and Methods From 2014 to 2018, we studied 57 adults who underwent an ECMO for at least 5 days. The plasma samples collected daily were tested for PF4-specific Abs using immunoassays to detect immunoglobulin (Ig) G, A, and M isotypes or only IgG. Serotonin release assay was performed without and with PF4 to detect pathogenic Abs. Results Twenty-nine patients (50%) were positive for PF4-specific Abs (IgG, A, M), with IgG in 17/57 (30%) and 16 of them (94%) were immunized within 10 days. PF4-specific IgG Abs did not affect the clinical or biological course of most patients. HIT was suspected in only two patients with ECMO circuit dysfunction and unexpected platelet count decrease after day 5. High levels of PF4-specific IgG were detected in both patients, and HIT was confirmed by a serotonin release assay, which was also more sensitive when exogenous PF4 was present. Conclusion PF4-specific Abs are common during ECMO but are mostly non-pathogenic and not associated with a less favorable prognosis. However, an abnormal platelet count evolution, in particular if associated with ECMO circuit dysfunction, should prompt the search for pathogenic PF4-specific IgG.
- Subjects :
- Adult
Blood Platelets
Male
0301 basic medicine
Serotonin
medicine.medical_specialty
Drug-Related Side Effects and Adverse Reactions
medicine.medical_treatment
030204 cardiovascular system & hematology
Platelet Factor 4
Gastroenterology
Leukocyte Count
Young Adult
03 medical and health sciences
Extracorporeal Membrane Oxygenation
0302 clinical medicine
Internal medicine
Extracorporeal membrane oxygenation
Humans
Medicine
Platelet
Prospective Studies
Prospective cohort study
Aged
Autoantibodies
Heart Failure
biology
Heparin
business.industry
Hematology
Middle Aged
medicine.disease
Thrombocytopenia
Immunity, Humoral
030104 developmental biology
Heart failure
Circulatory system
biology.protein
Female
France
Antibody
business
Platelet factor 4
medicine.drug
Subjects
Details
- ISSN :
- 2567689X and 03406245
- Volume :
- 119
- Database :
- OpenAIRE
- Journal :
- Thrombosis and Haemostasis
- Accession number :
- edsair.doi.dedup.....7677c55ff9d9b0805053cb7789e42492