Laboratory tests for identification or exclusion of heparin induced thrombocytopenia: HIT or miss?

Heparin induced thrombocytopenia (HIT) is a potentially fatal condition that arises subsequent to formation of antibodies against complexes containing heparin, usually platelet‐factor 4‐heparin (“anti‐PF4‐heparin”). Assessment for HIT involves both clinical evaluation and, if indicated, laboratory t...

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Bibliographic Details
Published in:American journal of hematology Vol. 93; no. 2; pp. 308 - 314
Main Author: Favaloro, Emmanuel J.
Format: Journal Article
Language:English
Published: United States Wiley Subscription Services, Inc 01.02.2018
Subjects:
Antibodies
Antibodies - blood
Anticoagulants
Chemiluminescence
Clinical Laboratory Techniques - methods
Diagnostic Errors
Enzyme-linked immunosorbent assay
Flow cytometry
Hematology
Heparin
Heparin - adverse effects
Humans
Immunology
Laboratories
Platelet Activation
Platelet aggregation
Sensitivity and Specificity
Serotonin
Thrombocytopenia
Thrombocytopenia - chemically induced
Thrombocytopenia - diagnosis
Thrombocytopenia - immunology
ISSN:0361-8609, 1096-8652, 1096-8652
Online Access:Get full text
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Summary:Heparin induced thrombocytopenia (HIT) is a potentially fatal condition that arises subsequent to formation of antibodies against complexes containing heparin, usually platelet‐factor 4‐heparin (“anti‐PF4‐heparin”). Assessment for HIT involves both clinical evaluation and, if indicated, laboratory testing for confirmation or exclusion, typically using an initial immunological assay (“screening”), and only if positive, a secondary functional assay for confirmation. Many different immunological and functional assays have been developed. The most common contemporary immunological assays comprise enzyme‐linked immunosorbent assay [ELISA], chemiluminescence, lateral flow, and particle gel techniques. The most common functional assays measure platelet aggregation or platelet activation events (e.g., serotonin release assay; heparin‐induced platelet activation (HIPA); flow cytometry). All assays have some sensitivity and specificity to HIT antibodies, but differ in terms of relative sensitivity and specificity for pathological HIT, as well as false negative and false positive error rate. This brief article overviews the different available laboratory methods, as well as providing a suggested approach to diagnosis or exclusion of HIT.
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ISSN:0361-8609
1096-8652
1096-8652
DOI:10.1002/ajh.24979