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Current insights into the laboratory diagnosis of HIT.
[heparin-induced thrombocytopenia]
Heparin-induced
thrombocytopenia
(
HIT
)
is
an
adverse
drug
reaction
and
prothrombotic
disorder
caused
by
immunization
against
platelet
factor
4
(
PF
4
)
after
complex
formation
with
heparin
or
other
polyanions
.
After
antibody
binding
to
PF
4
/
heparin
complexes
,
HIT
antibodies
are
capable
of
intravascular
platelet
activation
by
cross-linking
Fc
gamma
receptor
IIa
(
FcγRIIa
)
on
the
platelet
surface
leading
to
a
platelet
count
decrease
and
/
or
thrombosis
.
In
contrast
to
most
other
immune-mediated
disorders
,
the
currently
available
laboratory
tests
for
anti-
PF
4
/
heparin
antibodies
show
a
high
sensitivity
also
for
clinically
irrelevant
antibodies
.
This
makes
the
diagnosis
of
HIT
challenging
and
bears
the
risk
to
substantially
overdiagnose
HIT
.
The
strength
of
the
antigen
assays
for
HIT
is
in
ruling
out
HIT
when
the
test
is
negative
.
Functional
assays
have
a
higher
specificity
for
clinically
relevant
antibodies
,
but
they
are
restricted
to
specialized
laboratories
.
Currently
,
a
Bayesian
approach
combining
the
clinical
likelihood
estimation
for
HIT
with
laboratory
tests
is
the
most
appropriate
approach
to
diagnose
HIT
.
In
this
review
,
we
give
an
overview
on
currently
available
diagnostic
procedures
and
discuss
their
limitations
.
Diseases
Validation
Diseases presenting
"clinically irrelevant antibodies"
symptom
heparin-induced thrombocytopenia
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