A Novel PF4-Dependent Platelet Activation Assay Identifies Patients Likely to Have Heparin-Induced Thrombocytopenia/Thrombosis

Chest
Anand PadmanabhanRichard H Aster

Abstract

Almost without exception, patients with heparin-induced thrombocytopenia/thrombosis (HIT) have antibodies that recognize platelet factor 4 (PF4) in a complex with heparin; however, many heparin-treated patients without HIT are also antibody-positive. A platelet activation test, the serotonin release assay (SRA), is useful for identifying a subset of antibodies that are platelet-activating and most likely to cause HIT. However, this "gold standard" assay for HIT diagnosis is technically demanding and is routinely available only through referral laboratories, limiting its availability for timely diagnosis and management. We compared the diagnostic performance of the SRA with that of a technically simple platelet activation assay, the PF4-dependent P-selectin expression assay (PEA), which uses platelets pretreated with PF4 as targets for antibody detection. Archived serum samples from 91 patients for whom clinical information (HIT 4Ts [thrombocytopenia, timing of platelet count fall, thrombosis, and other causes of thrombocytopenia] score) was available were used. Patients with an intermediate 4Ts score and a PF4 ELISA (enzyme-linked immunosorbent assay) optical density ≥ 2.0, or a high 4Ts score and a PF4 ELISA optical density ≥ ...Continue Reading

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Citations

Apr 19, 2017·Blood·Gowthami M Arepally
Apr 22, 2017·Chest·Anand PadmanabhanRichard H Aster
Dec 7, 2018·Hematology·Tamam Bakchoul, Irene Marini
Aug 20, 2019·Journal of Thrombosis and Haemostasis : JTH·Zachary LiedermanRita Selby
Oct 30, 2019·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Qiaoyan GuoPing Luo
Oct 18, 2019·American Journal of Hematology·Theodore E WarkentinDonald M Arnold
Mar 21, 2020·Vascular Medicine·Marie Hogan, Jeffrey S Berger
Mar 14, 2020·Journal of Thrombosis and Haemostasis : JTH·Theodore E WarkentinIshac Nazy
Dec 4, 2016·Hematology·Oluwatoyosi Onwuemene, Gowthami M Arepally
May 15, 2018·International Journal of Laboratory Hematology·G ZhengT S Kickler
Sep 27, 2019·Blood Advances·Madelaine DuarteGrace M Lee
Jun 17, 2020·International Journal of Laboratory Hematology·Beng H Chong
Aug 25, 2020·Research and Practice in Thrombosis and Haemostasis·Richard R RikerDavid B Seder
Nov 5, 2019·Thrombosis Research·Divya ChawlaAnand Padmanabhan
Feb 14, 2021·Journal of Clinical Medicine·Matteo MarchettiLorenzo Alberio
Feb 26, 2021·Blood·Grace M Lee
Sep 9, 2020·Blood·Bethany Samuelson BannowAnand Padmanabhan
May 18, 2020·Translational Research : the Journal of Laboratory and Clinical Medicine·Gowthami M Arepally, Douglas B Cines
Apr 10, 2021·The New England Journal of Medicine·Andreas GreinacherSabine Eichinger
Jul 22, 2021·International Journal of Laboratory Hematology·Allyson M Pishko, Adam Cuker
Aug 14, 2021·Research and Practice in Thrombosis and Haemostasis·Julie KellyJean M Connors
Jul 16, 2021·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Kanika AroraZaher K Otrock

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