Comparison of three different immunoassays in the diagnosis of heparin-induced thrombocytopenia.

[heparin-induced thrombocytopenia]

Abstract Background : Heparin-induced thrombocytopenia (HIT ) is caused by platelet activating antibodies that recognize platelet factor 4 /heparin (PF 4 /H ) complexes . Laboratory testing plays a key role in the diagnosis of HIT . As functional assays are unfeasible for most clinical laboratories , antigen binding assays are commonly used in routine testing . However , their low specificity leads to overdiagnosis of HIT . Therefore , it is advisable to improve screening tests in this setting . Methods : Blood samples from 114 patients in whom HIT was suspected were investigated using a chemiluminescence test (HemosIL ® AcuStar HIT -IgG ), a PF 4 /H IgG enzyme immunoassay (Lifecodes PF 4 IgG ), an IgG-specific lateral flow immunoassay heparin-induced thrombocytopenia (LFI-HIT , STic Expert ® HIT ) and the heparin-induced platelet aggregation (HIPA ) test . Results : Twenty -nine (25 .4 %) out of 114 subjects with suspected HIT had a positive HIPA test . None of patients with a 4 Ts score <4 were positive at HIPA . HemosIL ® AcuStar HIT -IgG showed the best performance in term of sensitivity and specificity when used as single test . Receiver operating characteristic (ROC ) analysis showed optimization of sensitivity and specificity using a cut-off of 1 .13 U /mL (0 .95 and 0 .98 , respectively ). As an alternative approach , a strategy based on screening samples by STic Expert ® HIT and then retesting positive results by Lifecodes PF 4 IgG (cut-off 1 OD ) or HemosIL ® AcuStar HIT -IgG (cut-off 1 .3 U /mL ) showed a performance compared to a single test approach by HemosIL ® AcuStar HIT -IgG . Conclusions : The HemosIL ® AcuStar HIT or a combinatorial approach with the STic Expert ® HIT and the PF 4 /H IgG enzyme immunoassay provide an accurate diagnosis of immune HIT .

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Diseases presenting "blood samples" symptom

22q11.2 deletion syndrome

acute rheumatic fever

adrenomyeloneuropathy

alpha-thalassemia

aniridia

aromatase deficiency

benign recurrent intrahepatic cholestasis

canavan disease

classical phenylketonuria

cohen syndrome

congenital adrenal hyperplasia

congenital toxoplasmosis

cushing syndrome

dystrophic epidermolysis bullosa

epidermolysis bullosa simplex

erdheim-chester disease

erythropoietic protoporphyria

esophageal adenocarcinoma

fabry disease

familial mediterranean fever

heparin-induced thrombocytopenia

hirschsprung disease

hodgkin lymphoma, classical

homocystinuria without methylmalonic aciduria

kallmann syndrome

oculocutaneous albinism

oligodontia

oral submucous fibrosis

papillon-lefèvre syndrome

phenylketonuria

primary effusion lymphoma

scrub typhus

sneddon syndrome

systemic capillary leak syndrome

triple a syndrome

typhoid

von hippel-lindau disease

waldenström macroglobulinemia

well-differentiated liposarcoma

wolf-hirschhorn syndrome

x-linked adrenoleukodystrophy

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