Rapid determination of anti-heparin/platelet factor 4 antibody titers in the diagnosis of heparin-induced thrombocytopenia

The American Journal of Medicine
Lorenzo AlberioBernhard Lämmle

Abstract

Heparin-induced thrombocytopenia is mediated by antibodies directed against the heparin-platelet factor 4 (heparin/PF4) complex. Our aim was to investigate whether rapid measurement of anti-heparin/PF4 antibodies could improve the diagnostic workup of patients with suspected heparin-induced thrombocytopenia. We examined 148 consecutive patients in our laboratory between January 1995 and June 2001 for suspected heparin-induced thrombocytopenia. Clinical data allowed retrospective assessment of the likelihood of heparin-induced thrombocytopenia. Antibodies against the heparin/PF4 complex were detected by a rapid particle gel immunoassay. Anti-heparin/PF4 antibodies were detected in 69 (47%) of the 148 patients, at dilution titers from 1 to 256. Clinically "likely" or "very likely" heparin-induced thrombocytopenia was significantly more common in patients with titers >or=4 (95% [39/41]) than in those with undetectable antibodies (13% [9/70]; P <0.0001), a titer of 1 (18% [4/22]; P <0.0001), or a titer of 2 (33% [2/6]; P = 0.001). All 19 samples with a positive platelet aggregation test had anti-heparin/PF4 antibody titers of at least 4, including 15 samples with titers >or=32. Thromboembolic complications in heparin-treated patien...Continue Reading

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Citations

Mar 29, 2008·Journal of Thrombosis and Thrombolysis·Gowthami M Arepally, Marcie J Hursting
May 20, 2006·Thrombosis Research·Lorenz RischMarkus Schmugge
Sep 11, 2007·Journal of Thrombosis and Thrombolysis·Jovan PerunicicZorana Vasiljevic
Jan 12, 2010·Annual Review of Medicine·Gowthami M Arepally, Thomas L Ortel
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Aug 18, 2005·Seminars in Hematology·John L Francis

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