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Rapid exclusion of the diagnosis of immune HIT by AcuStar HIT and heparin-induced multiple electrode aggregometry.
[heparin-induced thrombocytopenia]
Accurate
diagnosis
of
heparin-induced
thrombocytopenia
(
HIT
)
is
essential
but
remains
challenging
.
We
have
previously
demonstrated
,
in
a
retrospective
study
,
the
usefulness
of
the
combination
of
the
4
Ts
score
,
AcuStar
HIT
and
heparin-induced
multiple
electrode
aggregometry
(
HIMEA
)
with
optimized
thresholds
.
We
aimed
at
exploring
prospectively
the
performances
of
our
optimized
diagnostic
algorithm
on
suspected
HIT
patients
.
The
secondary
objective
is
to
evaluate
performances
of
AcuStar
HIT
-
Ab
(
PF
4
-
H
)
in
comparison
with
the
clinical
outcome
.
116
inpatients
with
clinically
suspected
immune
HIT
were
included
.
Our
optimized
diagnostic
algorithm
was
applied
to
each
patient
.
Sensitivity
,
specificity
,
negative
predictive
value
(
NPV
)
,
positive
predictive
value
(
PPV
)
of
the
overall
diagnostic
strategy
as
well
as
AcuStar
HIT
-
Ab
(
at
manufacturer
's
thresholds
and
at
our
thresholds
)
were
calculated
using
clinical
diagnosis
as
the
reference
.
Among
116
patients
,
2
patients
had
clinically-diagnosed
HIT
.
These
2
patients
were
positive
on
AcuStar
HIT
-
Ab
,
AcuStar
HIT
-IgG
and
HIMEA
.
Using
our
optimized
algorithm
,
all
patients
were
correctly
diagnosed
.
AcuStar
HIT
-
Ab
at
our
cut-off
(
>
9
.
41
U
/
mL
)
and
at
manufacturer
's
cut-off
(
>
1
.
00
U
/
mL
)
showed
both
a
sensitivity
of
100
.
0
%
and
a
specificity
of
99
.
1
%
and
90
.
4
%
,
respectively
.
The
combination
of
the
4
Ts
score
,
the
HemosIL
®
AcuStar
HIT
and
HIMEA
with
optimized
thresholds
may
be
useful
for
the
rapid
and
accurate
exclusion
of
the
diagnosis
of
immune
HIT
.
Diseases
Validation
Diseases presenting
"positive predictive value"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
carcinoma of the gallbladder
cholangiocarcinoma
congenital adrenal hyperplasia
congenital diaphragmatic hernia
congenital toxoplasmosis
cushing syndrome
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
heparin-induced thrombocytopenia
hodgkin lymphoma, classical
phenylketonuria
thoracic outlet syndrome
typhoid
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