A novel diagnostic algorithm for heparin-induced thrombocytopenia.

International Journal of Laboratory Hematology
Gang ZhengThomas S Kickler

Abstract

While diagnostic algorithm using PF4-heparin enzyme-linked immunosorbent assay (ELISA) optical density (OD), and heparin neutralization assay (HNA), or 4T score have been proposed to replace serotonin-release assay (SRA) for heparin-induced thrombocytopenia (HIT), their performance against SRA is unclear. In this study, we proposed and validated the performance of a new algorithm combining PF4-heparin ELISA optical density (OD), HNA and 4T score against SRA for HIT diagnosis. Heparin neutralization assays were performed on specimens submitted for HIT testing with positive PF4-heparin ELISA from December 2015 to September 2017, which were separated into a "training" and a "validation" data set. 4T scores were calculated for ELISA positive cases. A total of 123 consecutive unique patient samples had positive PF4-heparin ELISA with also HNA data, SRA data, and 4T scores available. Compared to SRA, a "laboratory criteria" (ELISA OD ≥ 1.4 and HNA ≥ 70%) had a sensitivity of 88% (14/16) and specificity of 91% (42/46), and a "combined criteria" (4T score = 8, or 4T score = 6 or 7 and ELISA OD ≥ 1.0, or 4T score = 4 or 5 and ELISA OD ≥ 2.0) had a sensitivity of 75% (12/16) and specificity of 98% (45/46) in the training data set. Labora...Continue Reading

References

Nov 1, 1996·The American Journal of Medicine·T E Warkentin, J G Kelton
May 21, 2008·Journal of Thrombosis and Haemostasis : JTH·T E WarkentinJ G Kelton
Aug 13, 2014·Journal of Critical Care·Michael Nagler, Anne Angelillo-Scherrer

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Citations

Jan 3, 2021·Journal of Thrombosis and Thrombolysis·Zeina Marashi-SabouniLaurence Camoin-Jau

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