Abstract: FR-PO1018
Severe Thrombocytopenia with Epoprostenol in Infants on CKRT
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Timberline, Sage, Phoenix Children's Hospital, Phoenix, Arizona, United States
- Johnson, Sarah Kathleen, Phoenix Children's Hospital, Phoenix, Arizona, United States
- Zaritsky, Joshua, Phoenix Children's Hospital, Phoenix, Arizona, United States
- Papez, Karen E., Phoenix Children's Hospital, Phoenix, Arizona, United States
Introduction
Epoprostenol (EPOP) is a prostacyclin analog that inhibits platelet aggregation. In addition to use in pulmonary arterial hypertension (PAH), EPOP has recently been used as a regional platelet inhibitor in continuous kidney replacement therapy (CKRT), despite limited pediatric safety data and association with thrombocytopenia in adults with PAH. Pre-filter EPOP undergoes rapid metabolism and circuit clearance, so thrombocytopenia risk is thought to be low and it is often favored in thrombocytopenic patients or when heparin is contraindicated. We report three infants who developed severe thrombocytopenia during EPOP use, with improvement after transition to citrate in two patients.
Case Description
Patient 1 (3.5kg) was a full-term growth-restricted infant with congenital diaphragmatic hernia who required CKRT for fluid overload with sepsis at 1 month of age. Systemic heparin was used due to venous thromboses. EPOP was added on CKRT day 7 due to frequent circuit clotting. Filter longevity improved but she developed acute thrombocytopenia.
Patient 2 (3kg) was a growth-restricted infant of 28 weeks gestation with twin-to-twin transfusion syndrome and congenital renal failure. He transitioned from peritoneal dialysis to CKRT with EPOP at 3 months of age after necrotizing enterocolitis and peritonitis. Acute thrombocytopenia developed on EPOP. Transition to citrate on CKRT day 9 was followed by platelet recovery.
Patient 3 (3.4kg) was a malnourished infant of 35 weeks gestation admitted at 2 months of age after cardiac arrest due to septic shock. She required CKRT for oliguric renal failure. EPOP was associated with thrombocytopenia, bleeding, transfusions and circuit clots. Transition to citrate on CKRT day 24 was followed by resolution of bleeding and platelet recovery.
Discussion
All three infants developed severe thrombocytopenia during EPOP therapy. Despite their medical complexity, patients were relatively stable at thrombocytopenia onset with few other clinical changes. Patients transitioned to citrate had sustained platelet recovery (Figure). These cases suggest that even regional EPOP may contribute to thrombocytopenia, bleeding, platelet transfusion requirements, and CKRT circuit turnover. Recognition of this potential complication is important for patient selection, dialysis prescription, informed consent, and future study.