Heparin-induced thrombocytopenia (HIT II) - a drug-associated autoimmune disease

Autoimmune thrombocytopenia (ITP) is an acquired autoimmune disease characterised by isolated persistent thrombocytopenia and normal megakaryopoiesis. This definition also applies to heparin-induced thrombocytopenia (HIT II), a frequent side effect of heparin treatment. In HIT II, the immunogen is a...

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Bibliographic Details
Published in:Thrombosis and haemostasis Vol. 102; no. 5; p. 887
Main Author: Nowak, Götz
Format: Journal Article
Language:English
Published: Germany 01.11.2009
Subjects:
Adult
Aged
Anticoagulants - adverse effects
Anticoagulants - immunology
Anticoagulants - pharmacology
Anticoagulants - therapeutic use
Autoantibodies - biosynthesis
Autoantibodies - blood
Autoantibodies - immunology
Citrates - pharmacology
Early Diagnosis
Female
Heart Diseases - complications
Heart Diseases - drug therapy
Heart Diseases - immunology
Heparin - adverse effects
Heparin - immunology
Heparin - pharmacology
Heparin - therapeutic use
Humans
Immunoglobulin G - analysis
Immunoglobulin G - biosynthesis
Immunoglobulin G - immunology
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - drug therapy
Kidney Failure, Chronic - immunology
Male
Models, Immunological
Platelet Adhesiveness
Platelet Count - methods
Platelet Factor 4 - drug effects
Platelet Factor 4 - immunology
Purpura, Thrombocytopenic, Idiopathic - chemically induced
Purpura, Thrombocytopenic, Idiopathic - complications
Purpura, Thrombocytopenic, Idiopathic - diagnosis
Purpura, Thrombocytopenic, Idiopathic - immunology
Receptors, IgG - immunology
Renal Dialysis
Stroke - complications
Stroke - drug therapy
Stroke - immunology
ISSN:0340-6245, 2567-689X, 2567-689X
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Summary:Autoimmune thrombocytopenia (ITP) is an acquired autoimmune disease characterised by isolated persistent thrombocytopenia and normal megakaryopoiesis. This definition also applies to heparin-induced thrombocytopenia (HIT II), a frequent side effect of heparin treatment. In HIT II, the immunogen is a coagulation active complex of heparin and platelet factor 4 (PF4). By now, diagnostics of HIT II is often material and time consuming. Three groups of patients were investigated for HIT II antibodies (HIT II-AB): 54 hospitalised stroke patients, 87 hospitalised cardiac patients, and 71 patients on chronic haemodialysis, all treated with heparin. Furthermore, 100 healthy volunteers were investigated. For detection of HIT II-AB the innovative whole blood test PADA-HIT (PADA: platelet adhesion assay) was used. PADA-HIT quantifies the interaction of IgG antibodies with FcgammaIIA receptors by comparing the activation state of platelets in citrated and heparinised whole blood. The occurrence of HIT II-AB in blood was very high with 44 % of stroke patients, 69% of cardiac patients and 38% of haemodialysis patients compared to only 15% of healthy volunteers. This demonstrates a high incidence and a rapid onset of HIT II-AB in patients being acutely treated with heparin. HIT II is one of the most frequent and severe autoimmune diseases bearing a great thrombosis risk. PADA-HIT represents an innovative diagnostic method for detection of autoimmune antibodies of IgG type that are directed against platelet factor 4 (PF4)-heparin-complex. By early and fast diagnostics and appropriate treatment severe complications of HIT II can be prevented.
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ISSN:0340-6245
2567-689X
2567-689X
DOI:10.1160/TH09-03-0209