Application of a clinical decision rule and laboratory assays in pediatrics: Adult heparin-induced thrombocytopenia

Omri Cohen, Kfir Lange, Ivan Budnik, Ilia Tamarin, Tami Brutman-Barazani, Assaf Arie Barg, Nurit Rosenberg, Aharon Lubetsky, Gili Kenet, Sarina Levy-Mendelovich

Research output: Contribution to journalArticlepeer-review


Background: Heparin-induced thrombocytopenia (HIT) is rare among pediatric patients. The diagnosis of HIT depends upon clinical decision tools to assess its pretest probability, supported by laboratory evidence of anti-platelet factor 4 (anti-PF4)/heparin antibodies. Aims: To compare the use of the 4Ts score clinical decision tool, clinical characteristics, and laboratory findings between pediatric and adult patients with suspected HIT. Methods: We compiled all pediatric patients in our center for whom HIT testing was performed during the years 2015–2021. These were compared with a cohort of consecutive adult patients. Laboratory diagnosis of HIT was performed with particle gel immunoassay (PaGIA) as screening test and confirmed by an automated latex-enhanced immunoturbidimetric assay (LIA) and/or by functional flow cytometry assay (FCA). Results: The cohort included 34 children (under 18 years) and 105 adults. Adults mostly received heparins for thromboembolism prophylaxis and treatment (72.4%, n = 76), and were more frequently treated with low-molecular-weight heparin (LMWH). Children were mostly exposed during cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO, 61.8%, n = 21), and were more frequently treated with unfractionated heparin (UFH). Compared with adults, children had significantly higher 4Ts scores. Nevertheless, adults had a slightly higher rate of a positive diagnosis of HIT. Six out of 16 adults with confirmed HIT presented with thrombosis (37.5%), whereas all three pediatric patients with HIT presented with thrombosis (p =.087). Conclusions: 4Ts scores are higher in children compared with adult patients for whom laboratory tests for HIT were obtained. A potentially higher incidence of thrombosis in children with HIT may be attributable to the severity of underlying illness.

Original languageEnglish
Article numbere29929
JournalPediatric Blood and Cancer
Issue number11
StatePublished - Nov 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2022 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.


Omri Cohen and Sarina Levy‐Mendelovich have received IIS grants from Pfizer. This work was performed in partial fulfilment of the M.D. thesis rquirement of the Sackler Faculty of Medicine, Tel Aviv University.

FundersFunder number


    • heparin
    • heparin-induced thrombocytopenia
    • pediatric
    • platelets
    • thrombosis


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