Laboratory tests for the diagnosis of heparin-induced thrombocytopenia.
نویسندگان
چکیده
Heparin-induced thrombocytopenia (HIT) is associated with high morbidity and mortality. Because the pathophysiology of this complex disorder has remained unclear, so has the development of supportive diagnostic laboratory assays. The currently available laboratory methods for HIT diagnosis include several platelet function assays: the platelet aggregation assay, platelet aggregation with simultaneous measurement of ATP release (lumi-aggregometry), the serotonin release assay, and flow cytometric assays. ELISA assays, which quantitate anti-heparin/platelet factor 4 antibody titers, have recently become available. Assay characteristics for these assays were studied using sera collected from clinically diagnosed HIT patients with and without thrombosis, normal individuals, various types of hospitalized patients without HIT, heparin or low molecular weight heparin-treated patients without HIT, and patients with platelet-immune disorders other than HIT. The results of our studies suggest that none of the assays can be considered a "gold standard" for the laboratory diagnosis of HIT as many false-negative and false-positive results were obtained. Furthermore, antibodies against the heparin/platelet factor 4 complex, as identified by the current ELISA tests, are not the sole cause of HIT since many patients lacking clinical symptoms associated with HIT exhibited high antibody titers following heparin treatment. An assay using flow cytometry, being developed for HIT testing, will be described. At this time, clinical impression remains important for the diagnosis of HIT.
منابع مشابه
Heparin induced thrombocytopenia
Abstract Background and Objectives Heparin is still a commonly used anticoagulant in prophylaxis and treatment of thromboembolic events. Heparin-induced thrombocytopenia (HIT) is a life-threating adverse drug reaction of heparin. The diagnosis of HIT is made based on two important criteria, firstly clinical evaluation and secondly laboratory testing. In this comprehensive review, the authors w...
متن کاملClinical and laboratory diagnosis of heparin-induced thrombocytopenia: an integrated approach.
Heparin-induced thrombocytopenia (HIT) is a clinicopathologic disorder that predisposes to thrombosis. Diagnosis rests on a compatible clinical picture and laboratory evidence of antiplatelet factor 4 (PF4)/heparin antibodies that activate platelets in a heparin-dependent manner. Rapid and accurate diagnosis is paramount to avoid the perils of misdiagnosis. Clinical evaluation may be guided by ...
متن کاملDiagnosis and management of heparin-induced thrombocytopenia.
PURPOSE To review recent developments in the pathogenesis, clinical features, laboratory testing and treatment of heparin-induced thrombocytopenia (HIT). METHODS Narrative review of the literature, including relevant papers published in English or French. PRINCIPAL FINDINGS Although the prevalence of HIT has decreased with the widespread use of low molecular weight heparin in the past ten y...
متن کاملContributions of biological tests and the 4 Ts score in the diagnosis of Heparin Induced Thrombocytopenia
INTRODUCTION Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction caused by antibodies to the heparin/platelet factor 4 (PF4) complexes. HIT diagnosis is challenging and depends on clinical presentation and laboratory tests. We investigated the interest of the combined use of 4 Ts score and the functional and immunological tests for the diagnosis of HIT. METHODS We analyzed 178 ...
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عنوان ژورنال:
- Seminars in thrombosis and hemostasis
دوره 25 Suppl 1 شماره
صفحات -
تاریخ انتشار 1999