Congress of the International Society on Thrombosis and Haemostasis

A higher prevalence of hit antibodies in hemodialysis patients may be due to contaminated heparin

Abstract number: OC-TH-019

Walenga¹ J.M., Hoppensteadt² D., Cunanan² J., Adiguzel² C., Iqbal² O., Fareed² J.

¹¹Cardiovascular Institute ²²Pathology, Loyola University Medical Center, Maywood, IL, USA

How-to-cite Walenga JM, Hoppensteadt D, Cunanan J, Adiguzel C, Iqbal O, Fareed J. A higher prevalence of hit antibodies in hemodialysis patients may be due to contaminated heparin. Journal of Thrombosis and Haemostasis 2009; Volume 7, Supplement 2: Abstract OC-TH-019

From November 2007 until January 2008, an increased prevalence of adverse reactions to heparin in hemodialysis patients was noted. These adverse events were attributed to the presence of oversulfated chondroitin sulfate (OSCS). This OSCS exhibited a molecular profile similar to heparin (14–16 kDA) and produced HIT antibody mediated aggregation of platelets and serotonin release. Since some of the dialysis patients have been exposed to contaminated heparin, the OSCS may have triggered the generation of anti-heparin platelet factor 4 antibodies (HIT abs). Blood from 80 hemodialysis patients who were potentially exposed to contaminated heparin was drawn in June 2008. Plasma samples were analyzed for the presence of HIT abs using a commercially available ELISA kit from GTI (Brookfield, WI). Analysis of plasma obtained from banked dialysis patients’ plasma in 2006 and 2007 showed a very low prevalence of HIT abs (5%). While there was no change in the platelet count in the current patients, the prevalence of HIT abs was markedly higher 15/78 (19.2%) in plasma samples drawn in June 2008. Subtyping of the antibody also showed a higher prevalence of IgG subtype in contrast to the previously determined abs which were mainly IgA and IgM. OSCS was found to strongly complex with platelet factor 4 and initiate heparin induced platelet aggregation responses. These observations suggest that OSCS contaminant in recalled heparin is capable of triggering a differential immunogenic response in comparison to contaminant free heparin. Regardless of the increased generation of HIT abs no adverse events and/or thrombocytopenia were reported in these patients.

Disclosure of interest: none declared.

To cite this abstract use the following format:

Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number

Session Details

Date:	Unpresented
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Session name:	ISTH2009
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