| For more information on heparin, please refer to Injuryboard's heparin information page. |
It has reportedly happened before at Cedars-Sinai Medical Center in Los Angeles.
This time actor Dennis Quaid’s newborn twins are fighting for their lives after receiving an overdose of Heparin, an anti-coagulant, given to reduce the risk of blood clots.
Babies are routinely given 10 units but the twins, Thomas Boone and Zoe Grace were given 10,000 units Sunday. It's unclear whether they received the dose once or twice.
The babies began bleeding out and are now reported to be in stable condition at Cedars-Sinai neo-natal unit after receiving protamine sulfate, which reverses the effects of Heparin.
Heparin is routinely used in hospitals to prevent blood clots. A serious side-effect heparin-induced thrombocytopenia (HIT syndrome). HITS causes platelets to use up coagulation factors that can result in bleeding. TMZ is reporting that nurses mixed up the bottles after the drugs were kept in the wrong place.
Attorney Joe Saunders reporting on Injuryboard.com in February, writes that three infants died earlier this year when they too received higher doses of Heparin Sodium Injection at 10,000 units a mililiter. The 10,000 unit dose is in the same size vial as the lower dose with the only difference being a slightly different shade of blue on the label. The FDA and Bayer issued health warnings to hospitals.
The hospital’s chief medical Officer, Dr. Michael L. Langberg, has issued an apology.
Full Statement from Cedars-Sinai
Statement of Michael L. Langberg, MD Chief Medical Officer, Cedars-Sinai Medical Center:
“On November 18, three patients who were receiving intravenous medications as part of their treatment had their IV catheters flushed with a solution containing a higher concentration of heparin (a medication used to keep IV catheters from clotting) than normal protocol. As a result of a preventable error, the patients' IV catheters were flushed with heparin from vials containing a concentration of 10,000 units per milliliter instead of from vials containing a concentration of 10 units per milliliter.
The error was identified by Cedars-Sinai staff, who immediately performed blood tests on the patients to measure blood clotting function. Four additional patients in the unit were tested as a precaution. The tests indicated that four of the seven patients had normal blood clotting function, and three had tests indicating prolonged blood clotting function. In one of the three patients, the clotting tests returned quickly to normal. The other two patients were given protamine sulfate, a drug that reverses the effects of heparin and helps restore blood clotting function to normal. Additional medical tests and clinical evaluation conducted on the two patients indicated no adverse effects from the higher concentration of heparin or from the temporary abnormal clotting function. Doctors continue to monitor the patients.
I want to extend my deepest apologies to the families who were affected by this situation, and we will continue to work with them on any concerns or questions they may have. This was a preventable error, involving a failure to follow our standard policies and procedures, and there is no excuse for that to occur at Cedars-Sinai. Although it appears at this point that there was no harm to any patient, we take this situation very seriously. We are conducting a comprehensive investigation, cooperating fully with the Los Angeles County Department of Health Services and will take all necessary steps to ensure that this never happens here again.”
The public is very sympathetic if comments to the celebrity website TMZ are any indication. Some unsubstantiated reports say it's happened before at Cedars-Sinai.
The babies were born November 8th by a surrogate to actor Quaid and his wife, Kimberly Buffington.