Clinical and Applied Thrombosis/Hemostasis

 

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First published on September 25, 2007, doi:10.1177/1076029607304721
This version was published on February 4, 2008

Article

Serologic Results in >1000 Patients With Suspected Heparin-Induced Thrombocytopenia

Suresh G. Shelat, MD, PhD1*, Anne Tomaski2, and Eleanor S. Pollak, MD3

1 Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
2 Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
3 Hospital of the University of Pennsylvania and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

* To whom correspondence should be addressed. E-mail: suresh{at}alum.mit.edu.


  Abstract
Heparin-induced thrombocytopenia (HIT) can lead to life-threatening and limb-threatening thrombosis. HIT is thought to be initiated by the interaction of pathogenic antibodies toward a complex platelet factor 4 (PF4) and heparin (PF4:H), which can activate platelets and predispose to thrombosis. As such, the laboratory diagnosis of HIT includes antigenic and functional assays to detect antibodies directed at PF4:H complexes. We performed a retrospective analysis of 1017 consecutive samples tested by serotonin-release assay and by enzyme-linked immunosorbent assay (ELISA). Most samples showed no serologic evidence of HIT, whereas 4% to 5% of samples demonstrated both antigenic and functional serological evidence for HIT. Approximately 12% to 18% of samples showed immunologic evidence of anti-PF4:H antibodies but without functional evidence of serotonin release in vitro. Interestingly, a small minority of samples (0.7%) caused serotonin release but were negative in the ELISA. The results are presented using cutoff values established at our hospital and for the ELISA manufacturer. This study provides a pretest probability of the serologic results from an antigenic assay (ELISA) and a functional assay (serotonin-release assay) in patients clinically suspected of having HIT.


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