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Proficiency testing results for heparin-induced thrombocytopenia in north america.
[heparin-induced thrombocytopenia]
Between
2010
and
2012
,
North
American
Specialized
Coagulation
Laboratory
Association
(
NASCOLA
)
distributed
five
proficiency
testing
challenges
to
evaluate
laboratory
testing
for
heparin-induced
thrombocytopenia
(
HIT
)
.
Results
(
n
=
355
)
were
submitted
from
43
unique
laboratories
for
10
samples
(
3
positive
,
2
weak
positive
,
and
5
negative
)
.
The
vast
majority
of
results
were
from
commercial
enzyme-linked
immunosorbent
assay
(
ELISA
)
methods
,
predominantly
polyvalent
assays
.
Laboratories
performed
well
in
the
classification
of
clear
negative
and
positive
samples
.
All
results
(
100
%
)
submitted
for
the
five
negative
samples
(
n
=
173
)
and
97
%
of
immunological
results
submitted
for
the
three
positive
samples
(
n
=
105
)
were
correctly
classified
(
the
incorrect
responses
were
two
borderline
classifications
and
,
from
a
gel-agglutination
method
,
one
negative
classification
)
.
There
was
more
difficulty
in
the
classification
of
the
two
weak
positive
samples
(
n
=
70
)
.
In
one
survey
,
61
%
of
results
from
the
weak
positive
sample
were
classified
as
positive
,
while
21
%
were
called
negative
,
16
%
were
called
borderline
,
and
2
%
were
called
inconclusive
.
In
a
second
survey
,
16
%
of
results
from
the
weak
positive
sample
were
called
positive
,
while
56
%
were
called
negative
,
and
28
%
were
called
borderline
.
Significant
interlaboratory
variation
was
observed
for
ELISA
results
,
with
coefficients
of
variation
of
about
20
to
30
%
.
We
conclude
that
there
is
variability
in
HIT
laboratory
testing
and
that
identification
of
weak
positive
samples
can
be
challenging
.
Diseases
Validation
Diseases presenting
"weak positive"
symptom
heparin-induced thrombocytopenia
lymphangioleiomyomatosis
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