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Microvascular thrombosis in pediatric multiple organ failure: Is it a therapeutic target?

Nguyen, Trung MD; Hall, Mark MD; Han, Yong MD; Fiedor, Melinda MD; Hasset, Andrea PhD; Lopez-Plaza, Ileana MD; Watson, Scott MD; Lum, Lucy MD; Carcillo, Joseph A. MD

Pediatric Critical Care Medicine: July 2001 - Volume 2 - Issue 3 - pp 187-196
Invited Feature Reviews

Purpose: To discuss the current rationale for the use of specific and nonspecific therapies for thrombotic microangiopathy in thrombocytopenia-associated pediatric multiple organ failure syndromes.

Methods: Pertinent PubMed and MEDLINE citations and proceedings of recent critical care meeting presentations were reviewed.

Results: Critical care clinicians have reported using antithrombin III concentrate, protein C concentrate, activated protein C, prostacyclin and its analogues, heparin, tissue factor pathway inhibitor concentrate, plasma infusion, plasma exchange, whole blood exchange, pentoxifylline, tissue plasminogen activator, urokinase, and streptokinase with perceived therapeutic benefits in patients with thrombocytopenia-associated multiple organ failure, including those with thrombotic thrombocytopenic purpura/hemolytic uremic syndrome, disseminated intravascular coagulation syndrome, and secondary thrombotic microangiopathy syndrome without prolonged prothrombin time/activated partial thromboplastin time.

Conclusion: Assuming that underlying disease is remediable, a consensus has developed that thrombotic microangiopathy is a therapeutic target in children with thrombocytopenia-associated multiple organ failure syndromes. Studies are warranted to delineate efficacious use of specific and nonspecific therapies to prevent and reverse thrombotic microangiopathy in these patients.

From the Departments of Critical Care Medicine (Drs. Nguyen, Hall, Han, Fiedor, Watson, and Carcillo) and the Pathology (Dr. Lopez-Plaza), University of Pittsburgh School of Medicine, Pittsburgh, PA; the Institute for Transfusion Medicine, Pittsburgh, PA (Dr. Hasset); and the Department of Pediatrics, University of Malaya, Kuala Lampur, Indonesia (Dr. Lum).

Address requests for reprints to: Joseph A. Carcillo, MD, Division of Critical Care Medicine, Children’s Hospital of Pittsburgh, 3705 5th Avenue, Pittsburgh, PA 15213. E-mail: CarcilloJA@anes.upmc.edu

© 2001 Lippincott Williams & Wilkins, Inc.