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Increased Prevalence of Antiheparin Platelet Factor 4 Antibodies in Patients May Be Due to Contaminated Heparin

Department of Pathology, Loyola University Medical Center, Maywood, Illinois

Vinod Bansal, MD

Division of Nephrology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois

Evangelos Litinas, MD

Department of Pathology, Loyola University Medical Center, Maywood, Illinois

Josephine Cunanan, MD

Department of Pathology, Loyola University Medical Center, Maywood, Illinois

Omer Iqbal, MD

Department of Pathology, Loyola University Medical Center, Maywood, Illinois

Kelly Nelson, MS

Department of Pathology, Loyola University Medical Center, Maywood, Illinois

Meganathan Kannan, PhD

Center for Biologics Evaluation and Research, FDA Division of Hematology, Bethesda, Maryland

Debra Hoppensteadt, PhD

Department of Pharmacology, Loyola University Medical Center, Maywood, Illinois

Jawed Fareed, PhD

Department of Pharmacology, Loyola University Medical Center, Maywood, Illinois, jfareed{at}lumc.edu

During the period of November 2007 to January 2008, an increased prevalence of adverse reactions to heparin was noted. These adverse events have been attributed to the presence of purposeful contaminant, oversulfated chondroitin sulfate (OSCS) from April 2007 to May 2008. An analysis of dialysis patients' plasma obtained in 2006 and 2007 consistently had a low (5%) prevalence of AHPF4 antibodies. Blood samples from 78 patients on maintenance hemodialysis, who were potentially exposed to OSCS-contaminated heparin, were analyzed for the presence of all AHPF4 antibodies using a commercially available ELISA kit from GTI. Although there was no change in the platelet count of these patients, 15 of 78 patients (19.2%) studied had an increased prevalence of AHPF4 antibodies. Subtyping of the all platelet factor 4 (PF4) antibodies documented showed a higher prevalence of immunoglobulin G antibodies as compared to their previously determined antibodies. These observations suggest that the OSCS contaminant in the recalled heparin triggers an immunogenic response not seen with OSCS-contaminated free heparin.

Key Words: contaminated heparin • oversulfated chondroitin sulfate • heparin-induced thrombocytopenia • end-stage renal disease • antiheparin platelet factor 4 antibodies

Clinical and Applied Thrombosis/Hemostasis, Vol. 15, No. 2, 145-151 (2009)
DOI: 10.1177/1076029609332802


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