BOF: Clotting (Anticoagulation)

Which ONE of the following should NOT be given during the course of treating an infant with neonatal purpura fulminans?

a) Fresh frozen plasma

b) Platelet concentrates

c) Protein C concentrate

d) Unfractionated heparin

e) Warfarin

Answer:

d) Unfractionated heparin

Explanation:

Heparin is ineffective in the treatment of acute neonatal purpura fulminans, as are antiplatelet agents. The standard of care should be virally inactivated protein C concentrate with the disadvantage of short half life and need for long-term central venous catheter, or plasma, with the problem of volume overload. Warfarin should be used chronically, with the possibility of additional low molecular weight heparin if this proves ineffective at thrombus prevention. Platelets may be required during the DIC phase of the illness at presentation.

Reference:

Limperger V, Klostermeier UC, Kenet G, et al. Clinical and laboratory characteristics of children with venous thromboembolism and protein C-deficiency: an observational Israeli-German cohort study. Br J Haematol 2014;167:385–93.