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Pathogenic heparin-induced thrombocytopenia and thrombosis (HIT) antibodies determined by rapid functional flow cytometry.
- Source :
-
European journal of haematology [Eur J Haematol] 2019 Sep; Vol. 103 (3), pp. 225-233. Date of Electronic Publication: 2019 Jul 02. - Publication Year :
- 2019
-
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.<br />Methods: A simple FCA is described which avoids platelet manipulation, is highly specific and sensitive compared with SRA, and provides rapid results.<br />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 < 0.001). At a 92% sensitivity, the assay specificity was 96%.<br />Conclusions: The present FCA is practical for routine testing, providing prompt reliable results for initial diagnosis and confirmation, to effectively assist in HIT patient management.<br /> (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Autoantibodies immunology
Disease Management
Female
Humans
Immunoassay methods
Male
Middle Aged
Platelet Activation
Platelet Count
ROC Curve
Symptom Assessment
Thrombocytopenia blood
Thrombosis blood
Young Adult
Blood Platelets metabolism
Flow Cytometry methods
Heparin adverse effects
Thrombocytopenia diagnosis
Thrombocytopenia etiology
Thrombosis diagnosis
Thrombosis etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1600-0609
- Volume :
- 103
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- European journal of haematology
- Publication Type :
- Academic Journal
- Accession number :
- 31206215
- Full Text :
- https://doi.org/10.1111/ejh.13277