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

Favaloro, Emmanuel J.

doi:10.1002/ajh.24979

Cited by 20 publications

(26 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[60][61][62][63] Heparin-Induced Thrombocytopenia Heparin-induced thrombocytopenia (HIT) is a potentially fatal complication of heparin anticoagulant therapy, 64 and its diagnosis is facilitated by laboratory testing. 65 Of interest, most manufacturers of mainstream hemostasis instruments do not offer HIT testing on their mainstream instrument line. Notably, IL does offer such testing on both its AcuStar (chemiluminescence immunoassay) platform and also as an agglutination assay on other instrumentation.…”

Section: Assessing Factor Levels In the New Era Of Extended Life Factmentioning

confidence: 99%

Recent Advances in Mainstream Hemostasis Diagnostics and Coagulation Testing

Favaloro

Lippi

2019

Semin Thromb Hemost

View full text Add to dashboard Cite

The authors provide a narrative review of mainstream hemostasis analyzers. The review is presented in two parts. In the first part, the authors give voice to several internationally representative manufacturers of mainstream hemostasis analyzers. They ask these manufacturers to (1) answer a series of survey questions that may otherwise reflect common questions asked by users or potential users of their equipment, (2) provide a bullet list of their main focus areas, and (3) provide other information in regard to their instrumentation. The authors then offer their own personal perspective of the benefits of various aspects of such equipment, as well as a sampling of some hemostasis tests as currently available, or potentially in progress. It is hoped that this snapshot of mainstream hemostasis diagnostics and coagulation testing drives positive future changes that will ultimately provide the best outcomes for laboratories performing hemostasis assays and the patients they help diagnose and manage.

show abstract

Section: Assessing Factor Levels In the New Era Of Extended Life Factmentioning

confidence: 99%

Recent Advances in Mainstream Hemostasis Diagnostics and Coagulation Testing

Favaloro

Lippi

2019

Semin Thromb Hemost

View full text Add to dashboard Cite

show abstract

“…Immunoassays detect antibodies against heparin–PF4 complexes — these include both pathogenic and non‐pathogenic HIT antibodies . However, these assays generally have an excellent negative predictive value (Box 3).…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and management of heparin‐induced thrombocytopenia: a consensus statement from the Thrombosis and Haemostasis Society of Australia and New ZealandHITWriting Group

Joseph

Rabbolini

Enjeti

et al. 2019

Medical Journal of Australia

View full text Add to dashboard Cite

H eparin-induced thrombocytopenia (HIT) is a prothrombotic adverse reaction to heparin characterised by platelet-activating antibodies (almost exclusively IgG) that recognise and bind to platelet factor 4 (PF4)-heparin complexes. While antibody formation is common (up to 50% in the setting of cardiac surgery), only a small proportion of patients (0.2-3.0%) develop HIT (ie, thrombocytopenia and/or thrombosis). 1 Thrombosis can be arterial, venous or microvascular. Incidence of HIT varies depending on clinical setting (higher in surgical than medical, rarely in paediatric or obstetric), type of heparin (unfractionated heparin has higher rates than low molecular weight heparin), and dose (therapeutic v prophylactic). 2 PF4 tetramers (cationic) and heparin (anionic) associate by charge and hence certain molar concentrations (1:1 molar ratio) facilitate charge neutralisation, conformational change in PF4-exposing pathogenic epitopes, antibody binding and PF4-heparin-IgG complex formation. 3 PF4 can also bind to other polyanions, including glycosaminoglycans and chondroitin sulfate, and such interactions may play a role in the increasingly reported entity known as spontaneous HIT syndrome; that is, patients with clinical and laboratory features of HIT without exposure to heparin.Thrombocytopenia and thrombosis in HIT result from the binding of PF4-heparin-IgG complex to FcγRIIa receptors on the platelet surface. Subsequent cross-linking of the receptors leads to intense platelet activation, release of platelet granule content and procoagulant microparticles, thrombin generation, and activation of endothelial cells, neutrophils and monocytes. 4HIT is a clinicopathological entity and therefore requires integration of clinical and laboratory results. Accurate diagnosis is important and consultation with an appropriate specialist is recommended as delay in diagnosis and appropriate anticoagulant treatment is associated with an initial 6% daily risk of thromboembolism as well as amputation and death. 5 MethodsAustralian and New Zealand experts in the field of thrombosis and haemostasis who regularly diagnose and treat HIT syndrome were invited to a consensus statement development panel. This group, the Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ) HIT Writing Group, represents THANZ members and received formal endorsement from the THANZ President. A comprehensive literature review, using common online databases, was undertaken for each subsection by at least two authors. Major computerised databases such as Cochrane, MEDLINE and EMBASE were utilised. These searches were further supplemented with review of reference lists and professional society information available from internet sources. A draft for each subsection, collated by its two authors after extensive literature review, was submitted to the lead author (JJ). Following this comprehensive review of the literature, a face-to-face meeting was held over 2 days to discuss specific questions and finalise a draft of the consensus statement. Durin...

show abstract

“…Nález je pozitivní v případě průkazu uvolnění radionuklidem značeného serotoninu z trombocytů po expozici nízké koncentraci heparinu (senzitivita 90-98 %, specificita ≥ 95 %). Test SRA však není běžně dostupný, a proto se provádí i další funkční testy, mezi něž patří testy agregace trombocytů a průtoková cytometrie (3,6,(7)(8)(9)(10)(11)(12).…”

Section: úVodunclassified

Heparin-induced thrombocytopenia: a case report and literature overview

Polák¹,

Kaloudová²,

Krupicová³

et al. 2020

Vnitř Lék

View full text Add to dashboard Cite

Oddělení klinické hematologie FN Brno, pracoviště Bohunice 2 Klinika popálenin a plastické chirurgie LF MU a FN Brno, pracoviště Bohunice 3 Katedra laboratorních metod LF MU Brno 4 Ústav patologie LF MU a FN Brno, pracoviště Bohunice Heparinem indukovaná trombocytopenie (HIT) je imunologicky zprostředkovaná komplikace navazující zpravidla na expozici heparinu, méně často se rozvíjí po expozici jiným léčivům anebo spontánně. Mezi rizikové faktory rozvoje HIT patří typ použitého heparinu, jeho dávka a způsob aplikace i doba expozice, velké trauma či operace a obezita. Pravděpodobnost HIT dobře koreluje s tzv. 4 T -skóre. Laboratorní testy k potvrzení či vyloučení HIT se mají provádět u pacientů se střední až vysokou pravděpodobností HIT (4 T -skóre více než 3 body). Screeningové testy jsou založeny na průkazu protilátek proti komplexům heparinu a destičkového faktoru 4, cílem konfirmačních testů je průkaz aktivace trombocytů. Léčba HIT spočívá v okamžitém ukončení aplikace heparinu a v důsledné antitrombotické léčbě alternativními modalitami. Autoři popisují případ HIT u interně polymorbidní obézní pacientky s rozsáhlou infikovanou popáleninou projevující se extrémní urtikariální reakcí v místě aplikace nadroparinu a trombotizací žil podkoží. Díky včasné diagnostice a léčbě fondaparinuxem nedošlo k rozvoji závažnějších tromboembolických příhod.Klíčová slova: fondaparinux, heparinem indukovaná trombocytopenie, přímá perorální antikoagulancia, trombóza, 4 T -skóre. Heparin-induced thrombocytopenia: a case report and literature overviewHeparin-induced thrombocytopenia (HIT) is an immunologically-mediated complication, which usually follows heparin exposition, less frequently exposition to other drugs or even occurs spontaneously. The type of heparin, its dose and mode of application as well as the exposition time, major trauma or operation, and obesity represent the main risk factors for HIT. The probability of HIT correlates with so-called 4T-score. A confirmatory laboratory diagnostic should be exclusively reserved for patients with a medium to a high probability of HIT development (more than 3 points in 4T-score). The screening method is based on serological detection of antibodies against heparin-platelet factor-4 complexes; confirmation tests aim to identify the activation of platelets. The treatment of HIT requires an immediate interruption of heparin application and rigorous antithrombotic treatment with an alternative agent. Herein authors describe a clinical case of HIT manifested as an extreme urticarial reaction in the location of nadroparin application as well as thrombosis of deep subcutaneous veins in a polymorbid obese patient with an extensive and infected burn. Due to timely diagnosis and fondaparinux treatment, no more severe thrombotic events occurred in this patient.

show abstract

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

Cited by 20 publications

References 20 publications

Recent Advances in Mainstream Hemostasis Diagnostics and Coagulation Testing

Recent Advances in Mainstream Hemostasis Diagnostics and Coagulation Testing

Diagnosis and management of heparin‐induced thrombocytopenia: a consensus statement from the Thrombosis and Haemostasis Society of Australia and New ZealandHITWriting Group

Heparin-induced thrombocytopenia: a case report and literature overview

Contact Info

Product

Resources

About