Pathogenic heparin-induced thrombocytopenia and thrombosis (HIT) antibodies determined by rapid functional flow cytometry.
| Title: | Pathogenic heparin-induced thrombocytopenia and thrombosis (HIT) antibodies determined by rapid functional flow cytometry. |
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| Authors: | Cipok M; The Hematology Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Tomer A; The Hematology Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Elalamy I; Hematology and Thrombosis Center, Tenon University Hospital, INSERM UMRS 938, Sorbonne University, Paris, France.; Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.; Kirgner I; The Hematology Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Dror N; The Hematology Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Kay S; The Hematology Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Deutsch VR; The Hematology Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. |
| Source: | European journal of haematology [Eur J Haematol] 2019 Sep; Vol. 103 (3), pp. 225-233. Date of Electronic Publication: 2019 Jul 02. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Blackwell Country of Publication: England NLM ID: 8703985 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1600-0609 (Electronic) Linking ISSN: 09024441 NLM ISO Abbreviation: Eur J Haematol Subsets: MEDLINE |
| Imprint Name(s): | Publication: : Oxford : Blackwell; Original Publication: Copenhagen : Munksgaard, c1987- |
| MeSH Terms: | Flow Cytometry*/methods; Blood Platelets/*metabolism ; Heparin/*adverse effects ; Thrombocytopenia/*diagnosis ; Thrombocytopenia/*etiology ; Thrombosis/*diagnosis ; Thrombosis/*etiology; Autoantibodies/immunology ; Immunoassay/methods ; Thrombocytopenia/blood ; Thrombosis/blood ; Adult ; Aged ; Aged, 80 and over ; Disease Management ; Female ; Humans ; Male ; Middle Aged ; Platelet Activation ; Platelet Count ; ROC Curve ; Symptom Assessment ; Young Adult |
| Abstract: | Objectives: Reliable diagnosis of heparin-induced thrombocytopenia and thrombosis (HIT) is mandatory for patient management, yet prompt determination of pathogenic antibodies remains an unmet clinical challenge. Common immunoassays carry inherent limitations and functional assays which detect antibody-mediated platelet activation are not usually readily available to routine laboratories, especially the serotonin release assay (SRA), being technically demanding, time consuming, and requires high level expertise. To overcome some of these limitations, we have developed a practical functional flow cytometric assay (FCA) for routine clinical use.; Methods: A simple FCA is described which avoids platelet manipulation, is highly specific and sensitive compared with SRA, and provides rapid results.; Results: Of the 650 consecutive samples, from HIT-suspected patients, 99 (15.3%) were positive by the PaGIA Heparin/PF4 immunoassay and 31 (4.8%) by FCA. Average platelet activation was 11-fold higher in PaGIA+/FCA+ vs PaGIA-/FCA- samples. Of 21 SRA-positive samples, 19 were FCA-positive (relative sensitivity 90.5%), and of 42 SRA-negative samples, 40 were FCA-negative (relative specificity 95.2%). The FCA showed significantly higher correlation with the clinical presentation of HIT (4Ts score) performed on 182 patients, compared with PaGIA Heparin/PF4 (ROC-plot analysis, AUC 0.93 vs 0.63, P |
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| Contributed Indexing: | Keywords: antibodies; flow cytometry; heparin-induced; thrombocytopenia; thrombosis |
| Substance Nomenclature: | 0 (Autoantibodies); 9005-49-6 (Heparin) |
| Entry Date(s): | Date Created: 20190618 Date Completed: 20200124 Latest Revision: 20200124 |
| Update Code: | 20260130 |
| DOI: | 10.1111/ejh.13277 |
| PMID: | 31206215 |
| Database: | MEDLINE |
Journal Article