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Heparin: induced thrombocytopenia: incidence and laboratory approach to diagnosis in Indians.
[heparin-induced thrombocytopenia]
One
of
the
most
common
complications
of
heparin
administration
is
heparin-induced
thrombocytopenia
(
HIT
)
which
can
also
lead
to
catastrophic
thrombotic
events
.
The
problem
of
identifying
the
cause
of
thrombocytopenia
,
as
due
to
heparin
,
in
patients
with
multiple
co
-morbid
conditions
is
very
essential
for
management
.
Thus
,
the
laboratory
investigations
for
diagnosis
of
HIT
play
a
pivotal
role
.
The
objective
of
the
study
was
to
arrive
at
the
incidence
of
HIT
in
ethnic
Indian
population
and
provide
a
decision
after
analysis
of
tests
used
to
diagnose
HIT
.
125
consecutive
patients
(
Power
of
study
being
80
%
)
undergoing
open
heart
surgery
and
receiving
unfractionated
heparin
were
taken
as
subjects
.
Blood
samples
were
collected
a
day
before
the
surgery
and
days
1
,
3
,
5
and
7
after
surgery
.
The
cases
were
categorized
into
probable
and
unlikely
groups
depending
on
the
clinical
presentation
and
degree
fall
of
platelet
count
.
Anti-heparin
PF
4
-
associated
antibodies
were
detected
using
rapid-
ID
gel
microtyping
system
and
ELISA
tests
.
HIT
was
also
tested
using
functional
assays
:
heparin-induced
platelet
aggregation
test
(
PAT
)
and
the
rapid
luminographic
assay
of
heparin-induced
ATP
release
.
Of
the
125
patients
,
11
patients
were
clinically
labeled
as
probable
HIT
and
29
patients
were
clinically
labeled
as
unlikely
HIT
.
There
were
seven
confirmed
cases
of
HIT
cases
that
were
positive
for
one
functional
and
one
immunological
assay
.
Only
one
case
of
HITT
was
encountered
.
Accordingly
,
the
incidence
of
HIT
was
found
to
be
5
.
6
%
and
that
of
HITT
to
be
0
.
8
%
.
ELISA
tests
were
positive
in
21
cases
(
17
%
)
which
demonstrated
the
presence
of
anti-
HPF
4
antibodies
in
non-
HIT
cases
as
well
.
It
was
found
that
the
rapid
gel
test
had
sensitivity
comparable
to
functional
assay
with
better
specificity
than
ELISA
.
Incidence
of
HIT
in
ethnic
Indian
population
is
5
.
6
%
.
Patients
with
a
drop
of
>
50
%
in
platelet
count
should
be
perused
as
a
likely
candidate
of
HIT
.
These
cases
should
be
subjected
to
the
ID
-HPF
4
antibody
assay
as
this
is
a
rapid
test
,
can
be
done
for
individual
cases
,
and
has
better
specificity
and
similar
sensitivity
than
ELSIA
.
Cases
with
clinically
probable
HIT
and
a
positive
ID
-HPF
4
assay
can
be
taken
as
confirmed
cases
of
HIT
.
However
,
cases
clinically
unlikely
for
HIT
and
a
positive
ID
-HPF
4
assay
should
be
subjected
to
another
test
to
establish
the
diagnosis
of
HIT
.
Diseases
Validation
Diseases presenting
"thrombocytopenia"
symptom
22q11.2 deletion syndrome
adrenomyeloneuropathy
dedifferentiated liposarcoma
erythropoietic protoporphyria
esophageal adenocarcinoma
heparin-induced thrombocytopenia
hodgkin lymphoma, classical
holt-oram syndrome
homocystinuria without methylmalonic aciduria
liposarcoma
malignant atrophic papulosis
monosomy 21
oculocutaneous albinism
scrub typhus
sneddon syndrome
typhoid
waldenström macroglobulinemia
wiskott-aldrich syndrome
This symptom has already been validated