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Fondaparinux in an obese child with heparin-induced thrombocytopenia and a history of renal failure.
[heparin-induced thrombocytopenia]
A
9
-
year
-old
obese
child
with
a
history
of
ulcerative
colitis
was
admitted
to
the
intensive
care
unit
for
significant
blood
loss
,
hemorrhagic
shock
,
and
acute
renal
failure
.
Following
complications
from
total
colectomy
secondary
to
multiple
perforations
,
the
patient
developed
heparin-induced
thrombocytopenia
(
HIT
)
and
subsequent
portal
vein
thrombosis
.
Subcutaneous
(
SQ
)
fondaparinux
therapy
was
initiated
because
the
patient
was
unable
to
transition
to
oral
anticoagulation
.
An
anti-
factor
Xa
assay
was
developed
and
used
to
adjust
his
fondaparinux
therapy
.
Based
on
hemorrhagic
complications
and
fondaparinux-based
anti-
factor
Xa
assay
results
,
the
fondaparinux
was
adjusted
to
a
final
dosage
of
4
.
5
mg
(
0
.
066
mg
/
kg
)
SQ
daily
.
In
children
unable
to
transition
to
oral
anticoagulation
,
fondaparinux
may
be
an
alternative
for
the
treatment
of
thrombosis
associated
with
HIT
.
We
noted
that
our
patient
required
a
lower
dose
per
kilogram
of
fondaparinux
than
described
in
previous
published
reports
.
Despite
this
lower
dosage
per
kilogram
,
our
patient
developed
bleeding
despite
dosage
reductions
;
subsequently
,
a
few
doses
were
held
.
It
is
unclear
if
this
was
related
to
his
obesity
,
history
of
renal
failure
,
or
a
combination
of
factors
.
Future
studies
should
determine
the
optimal
dose
for
special
populations
of
children
(
e
.
g
.
,
those
with
obesity
and
renal
failure
)
.
Until
then
,
clinicians
should
routinely
monitor
and
titrate
fondaparinux
therapy
,
ideally
using
a
fondaparinux-
specific
anti-
factor
Xa
assay
.
Diseases
Validation
Diseases presenting
"obesity"
symptom
acute rheumatic fever
adrenal incidentaloma
aniridia
aromatase deficiency
carcinoma of the gallbladder
cohen syndrome
congenital adrenal hyperplasia
cushing syndrome
cystinuria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
familial hypocalciuric hypercalcemia
familial mediterranean fever
heparin-induced thrombocytopenia
kabuki syndrome
monosomy 21
phenylketonuria
primary hyperoxaluria type 1
sneddon syndrome
werner syndrome
wolf-hirschhorn syndrome
x-linked adrenoleukodystrophy
This symptom has already been validated