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Plasma exchange to remove HIT antibodies: dissociation between enzyme-immunoassay and platelet activation test reactivities.
[heparin-induced thrombocytopenia]
Repeated
therapeutic
plasma
exchange
(
TPE
)
has
been
advocated
to
remove
heparin-induced
thrombocytopenia
(
HIT
)
IgG
antibodies
prior
to
cardiac
/
vascular
surgery
in
patients
who
have
serologically-confirmed
acute
or
subacute
HIT
;
for
this
situation
,
a
negative
platelet
activation
assay
(
e
.
g
.
,
platelet
serotonin-release
assay
[
SRA
]
)
has
been
recommended
as
the
target
serological
endpoint
to
permit
safe
surgery
.
We
compared
reactivities
in
the
SRA
and
an
anti-
PF
4
/
heparin
IgG-
specific
enzyme-immunoassay
(
EIA
)
,
testing
serial
serum
samples
in
a
patient
with
recent
(
subacute
)
HIT
who
underwent
serial
TPE
pre-
cardiac
surgery
,
as
well
as
for
15
other
serially-diluted
HIT
sera
.
We
observed
that
post-
TPE
/
diluted
HIT
sera-when
first
testing
SRA-negative-continue
to
test
strongly
positive
by
EIA-IgG
.
This
dissociation
between
the
platelet
activation
assay
and
a
PF
4
-
dependent
immunoassay
for
HIT
antibodies
indicates
that
patients
with
subacute
HIT
undergoing
repeated
TPE
prior
to
heparin
re
-exposure
should
be
tested
by
serial
platelet
activation
assays
even
when
their
EIAs
remain
strongly
positive
.
Diseases
Validation
Diseases presenting
"platelet activation assay"
symptom
heparin-induced thrombocytopenia
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