Thromb Haemost 1980; 43(01): 061-065
DOI: 10.1055/s-0038-1650013
Original Article
Schattauer GmbH Stuttgart

Heparin Induced Thrombocytopenia: a Prospective Study

Jack Ansell
The Departments of Medicine, Veterans Administration Hospital, Boston, Massachusetts and University of Massachusetts Medical Center, Worcester, Massachusetts, U.S.A.
,
Nicholas Slepchuk Jr.
The Departments of Medicine, Veterans Administration Hospital, Boston, Massachusetts and University of Massachusetts Medical Center, Worcester, Massachusetts, U.S.A.
,
Raminder Kumar
The Departments of Medicine, Veterans Administration Hospital, Boston, Massachusetts and University of Massachusetts Medical Center, Worcester, Massachusetts, U.S.A.
,
Aaron Lopez
The Departments of Medicine, Veterans Administration Hospital, Boston, Massachusetts and University of Massachusetts Medical Center, Worcester, Massachusetts, U.S.A.
,
Luzbella Southard
The Departments of Medicine, Veterans Administration Hospital, Boston, Massachusetts and University of Massachusetts Medical Center, Worcester, Massachusetts, U.S.A.
,
Daniel Deykin
The Departments of Medicine, Veterans Administration Hospital, Boston, Massachusetts and University of Massachusetts Medical Center, Worcester, Massachusetts, U.S.A.
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Publikationsverlauf

Received 25. Oktober 1979

Accepted 30. Januar 1980

Publikationsdatum:
13. Juli 2018 (online)

Summary

Thrombocytopenia occurred in 11.6% of 43 patients prospectively randomized to receive either bovine lung or porcine mucosal heparin. Four patients received bovine heparin and developed mild to moderate thrombocytopenia after eight to twelve days which resolved when therapy was stopped in one to six days. One patient received porcine heparin and developed mild thrombocytopenia after four days. The thrombocytopenia resolved in one day in spite of continued heparin therapy.

Serial blood samples from the five thrombocytopenic patients were studied for their in vitro effect upon normal platelets. These samples induced a high release of serotonin from normal platelets or caused normal platelets to aggregate in the presence of additional heparin. Release or aggregation coincided with or occurred shortly after nadir platelet counts were reached and returned toward normal following cessation of heparin.

Our data constitute the first prospective study of heparin induced thrombocytopenia in which serial blood samples were studied before, during and following the onset of thrombocytopenia. They strongly support the presence of a heparin dependent co-factor, presumably an antibody, as the cause for thrombocytopenia.

 
  • References

  • 1 Copley AL, Robb TP. The effect of heparin in vivo on the platelet count in mice and dogs. A J Clin Path 1942; 12: 563-570
  • 2 Fidlar E, Jaques LB. The effect of commercial heparin on the platelet count. J Lab Clin Med 1948; 33: 1410-1423
  • 3 Eika C, Godal HC. Thrombocytopenia in rabbits induced by heparin, protamine, and polybrene. Scand J Haemat 1971; 8: 481-486
  • 4 Quick AJ, Shanberge JM, Stefanini M. The effect of heparin on platelets in vivo. J Lab Clin Med 1948; 33: 1424-1430
  • 5 Gollub S, Ulin AW. Heparin-induced thrombocytopenia in man. J Lab Clin Med 1962; 59: 430-435
  • 6 Ansell JE, Deykin D. Heparin induced thrombocytopenia and recurrent thromboembolism. American Journal Hematology (in press)
  • 7 Natelson EA, Lynch EC, Alfrey CP, Gross JB. Heparin-induced thrombocytopenia. Ann Int Med 1969; 71: 1121-1125
  • 8 Bell WR, Tomasulo PA, Alving BM, Duffy TP. Thrombocytopenia occurring during the administration of heparin. Ann Int Med 1976; 85: 155-160
  • 9 Fratantoni JC, Pollat R, Gralnick H. Heparin-induced thrombocytopenia: Confirmation of diagnosis with in vitro methods. Blood 1975; 45: 395-401
  • 10 Babcock RB, Dumper CW, Scharfman WB. Heparin-induced immune thrombocytopenia. N Eng J Med 1976; 295: 237-241
  • 11 Green D, Harris K, Reynolds N, Roberts M, Patterson R. Heparin immune thrombocytopenia: Evidence for a heparin-platelet complex as the antigenic determinant. J Lab Clin Med 1978; 91: 167-175
  • 12 Trowbridge AA, Caraveo J, Green JB, Amaral B, Stone MJ. Heparin-related immune thrombocytopenia. Am J Med 1978; 65: 277-283
  • 13 Cimo PL, Moake JL, Weinger RS, Ben-Menachem Y, Khalil KG. Heparin induced thrombocytopenia: Association with a platelet aggregating factor and arterial thromboses. Am J Hemat 1979; 6: 125-133
  • 14 Clauss A. Gerinnungsphysiologische Schnellmethoden zur Bestimmung des Fibrinogens. Acta Haematol 1957; 17: 237-246
  • 15 Leavelle DE, Mertens BF, Bowie EJ W, Owen CA. Staphylococcal clumping on microtiter plates. Am J Clin Pathol 1971; 55: 452-457
  • 16 Hienrich D, Gutschank S, Mueller-Eckhart C. HLA-Antibody induced 14C-serotonin release from platelets. Vox Sang 1977; 33: 65-78
  • 17 Deykin D, Hellerstein LJ. The assessment of drug-dependent and isoimmune antiplatelet antibodies by use of platelet aggregometry. J Clin Invest 1972; 51: 3142-3153
  • 18 Justus PG, Juneta HS, Noyes WD. Heparin associated thrombocytopenia. Clin Res 1976; 24: 17 A
  • 19 Stevenson M. Thrombocytopenia during heparin therapy. N Engl J Med 1976; 295: 1200-1201
  • 20 Gallus AS, Goodall KT. Heparin-associated thrombocytopenia: A prospective study. XVII Cong Int Soc Haemat 1978 p. 961
  • 21 Laake K, Eika C, Hamborg T. Heparinindusert trombocytopeni. Tidsskr Nor Laegeforen 1978; 98: 641
  • 22 Eika C, Godal HC, Laake K, Hamborg T. Low incidence of thrombocytopenia during treatment with hog mucosa heparin. XVII Cong Int Soc Haemat 1978; p. 961
  • 23 Malcolm ID, Wigmore TA, Steinbrecher UP. Heparin-associated thrombocytopenia: Low frequency in 104 patients treated with heparin of intestinal mucosal origin. CMA J 1979; 120: 1086-1088
  • 24 Powers PJ, Cuthbert D, Hirsch J. Thrombocytopenia found uncommonly during heparin therapy. JAMA 1979; 241: 2396-2397
  • 25 Nelson JD, Lerner RG, Goldstein R, Cagin MA. Heparin-induced thrombocytopenia. Arch Int Med 1978; 138: 548-552
  • 26 Rhodes GR, Dixon RH, Silver D. Heparin induced thrombocytopenia. Ann Surg 1977; 186: 752-758
  • 27 Wahl TO, Lipschitz DA, Stechschulte DJ. Thrombocytopenia associated with antiheparin antibody. JAMA 1978; 240: 2560-2562