Vnitr Lek 2012, 58(7-8):128-134

Diagnosis of heparin-induced thrombocytopenia in the Czech Republic

J. Gumulec
Ústav klinické hematologie FN Ostrava, přednosta prim. MUDr. Jaromír Gumulec

Heparin-induced thrombocytopenia is a prothrombotic adverse effect induced by platelet-activating antibodies against complexes of platelet factor 4 and heparin. Diagnosis rests on a clinical assesment of disease probability and laboratory testing. In this review, I describe some approaches to the evaluation of patients with suspected heparin-induced thrombocytopenia. In conclusion I draw attention to some of the reserves in the diagnostic approaches to this potentially fatal disorder in the Czech Republic.

Keywords: heparin-induced thrombocytopenia; heparin; diagnostic procedure; rapid testing; immunoassay; functional tests

Received: May 21, 2012; Published: July 1, 2012  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Gumulec J. Diagnosis of heparin-induced thrombocytopenia in the Czech Republic. Vnitr Lek. 2012;58(7-8):128-134.
Download citation

References

  1. Kelton JG, Sheridan D, Santos A et al. Heparin-induced thrombocytopenia: laboratory studies. Blood 1988; 72: 925-930. Go to original source...
  2. Lindhoff-Last E, Nakov R, Misselwitz F et al. Incidence and clinical relevance of heparin-induced antibodies in patients with deep vein thrombosis treated with unfractionated or low-molecular-weight heparin. Br J Haematol 2002; 118: 1137-1142. Go to original source... Go to PubMed...
  3. Greinacher A, Juhl D, Strobel U et al. Heparin-induced thrombocytopenia: a prospective study on the incidence, platelet-activating capacity and clinical significance of antiplatelet factor 4/heparin antibodies of the IgG, IgM, and IgA classes. J Thromb Haemost 2007; 5: 1666-1673. Go to original source... Go to PubMed...
  4. Chong BH, Murray B, Berndt MC et al. Plasma P-selectin is increased in thrombotic consumptive platelet disorders. Blood 1994; 83: 1535-1541. Go to original source...
  5. Warkentin TE, Chong BH, Greinacher A. Heparin-induced thrombocytopenia: towards consensus. Thromb Haemost 1998; 79: 1-7. Go to original source... Go to PubMed...
  6. Warkentin TE, Greinacher A, Koster A et al. American College of Chest Physicians. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th ed.). Chest 2008; 133 (6 Suppl): 340S-380S. Go to original source...
  7. Arepally GM, Ortel TL. Clinical practice. Heparin-induced thrombocytopenia. N Engl J Med 2006; 355: 809-817. Go to original source... Go to PubMed...
  8. Greinacher A. Heparin-induced thrombocytopenia. J Thromb Haemost 2009; 7 (Suppl 1): 9-12. Go to original source... Go to PubMed...
  9. Warkentin TE, Kelton JG. Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med 2001; 344: 1286-1292. Go to original source... Go to PubMed...
  10. Greinacher A, Kohlmann T, Strobel U et al. The temporal profile of the anti-PF4/heparin immune response. Blood 2009; 113: 4970-4976. Go to original source... Go to PubMed...
  11. Lubenow N, Kempf R, Eichner A et al. Heparin-induced thrombocytopenia: temporal pattern of thrombocytopenia in relation to initial use or reexposure to heparin. Chest 2002; 122: 37-42. Go to original source... Go to PubMed...
  12. Lo G K, Juhl D, Warkentin TE et al. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 2006; 4: 759-765. Go to original source... Go to PubMed...
  13. Warkentin TE. Heparin-induced thrombocytopenia: pathogenesis and management. Br J Haematol 2003; 121: 535-555. Go to original source... Go to PubMed...
  14. Pouplard C, Gueret P, Fouassier M et al. Prospective evaluation of the '4Ts' score and particle gel immunoassay specific to heparin/PF4 for the diagnosis of heparin-induced thrombocytopenia. J Thromb Haemost 2007; 5: 1373-1379. Go to original source... Go to PubMed...
  15. Cuker A, Arepally G, Crowther MA et al. The HIT Expert Probability (HEP) Score: a novel pre-test probability model for heparin-induced thrombocytopenia based on broad expert opinion. J Thromb Haemost 2010; 8: 2642-2650. Go to original source... Go to PubMed...
  16. Sheridan D, Carter C, Kelton JG. A diagnostic test for heparin-induced thrombocytopenia. Blood 1986; 67: 27-30. Go to original source...
  17. Pouplard C, Amiral J, Borg JY et al. Differences in specificity of heparin-dependent antibodies developed in heparin-induced thrombocytopenia and consequences on cross-reactivity with danaparoid sodium. Br J Haematol 1997; 99: 273-280. Go to original source... Go to PubMed...
  18. Pouplard C, Amiral J, Borg JY et al. Decision analysis for use of platelet aggregation test, carbon 14-serotonin release assay, and heparin-platelet factor 4 enzyme-linked immunosorbent assay for diagnosis of heparin-induced thrombocytopenia. Am J Clin Pathol 1999; 111: 700-706. Go to original source... Go to PubMed...
  19. Schenk S, El-Banayosy A, Morshuis M et al. IgG classification of anti-PF4/heparin antibodies to identify patients with heparin-induced thrombocytopenia during mechanical circulatory support. J Thromb Haemost 2007; 5: 235-241. Go to original source... Go to PubMed...
  20. Greinacher A, Michels I, Kiefel V et al. A rapid and sensitive test for diagnosing heparin-associated thrombocytopenia. Thromb Haemost 1991; 66: 734-736. Go to original source... Go to PubMed...
  21. Warkentin TE, Sheppard JA, Moore JC et al. Laboratory testing for the antibodies that cause heparin-induced thrombocytopenia: how much class do we need? J Lab Clin Med 2005; 146: 341-346. Go to original source... Go to PubMed...
  22. Alberio L, Kimmerle S, Baumann A et al. Rapid determination of anti-heparin/platelet factor 4 antibody titers in the diagnosis of heparin-induced thrombocytopenia. Am J Med 2003; 114: 528-536. Go to original source... Go to PubMed...
  23. Juhl D, Eichler P, Lubenow N et al. Incidence and clinical significance of anti-PF4/heparin antibodies of the IgG, IgM, and IgA class in 755 consecutive patient samples referred for diagnostic testing for heparin-induced thrombocytopenia. Eur J Haematol 2006; 76: 420-426. Go to original source... Go to PubMed...
  24. Warkentin TE. New approaches to the diagnosis of heparin-induced thrombocytopenia. Chest 2005; 127 (2 Suppl): 35S-45S. Go to original source... Go to PubMed...
  25. Warkentin TE. Platelet count monitoring and laboratory testing for heparin-induced thrombocytopenia. Arch Pathol Lab Med 2002; 126: 1415-1423. Go to original source...
  26. Shaheed G, Malkovska V, Mendoza J et al. PF4 ENHANCED assay for the diagnosis of heparin-induced thrombocytopenia in complex medical and surgical patients. Crit Care Med 2007; 35: 1691-1695. Go to original source... Go to PubMed...
  27. Zwicker JI, Uhl L, Huang WY et al. Thrombosis and ELISA optical density values in hospitalized patients with heparin-induced thrombocytopenia. J Thromb Haemost 2004; 2: 2133-2137. Go to original source... Go to PubMed...
  28. Warkentin TE, Sheppard JI, Moore JC et al. Quantitative interpretation of optical density measurements using PF4-dependent enzyme-immunoassays. J Thromb Haemost 2008; 6: 1304-1312. Go to original source... Go to PubMed...
  29. Whitlatch NL, Perry SL, Ortel TL. Anti-heparin/platelet factor 4 antibody optical density values and the confirmatory procedure in the diagnosis of heparin-induced thrombocytopenia. Thromb Haemost 2008; 100: 678-684. Go to original source... Go to PubMed...
  30. Warkentin TE, Sheppard JI. No significant improvement in diagnostic specificity of an anti-PF4/polyanion immunoassay with use of high heparin confirmatory procedure. J Thromb Haemost 2006; 4: 281-282. Go to original source... Go to PubMed...
  31. Warkentin TE, Levine MN, Hirsh J et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med 1995; 332: 1330-1335. Go to original source... Go to PubMed...
  32. Warkentin TE, Sheppard JA, Moore JC et al. Studies of the immune response in heparin-induced thrombocytopenia. Blood 2009; 113: 4963-4969. Go to original source... Go to PubMed...
  33. Warkentin TE, Roberts RS, Hirsh J et al. An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients. Arch Intern Med 2003; 163: 2518-2524. Go to original source... Go to PubMed...
  34. Sachs UJ, von Hesberg J, Santoso S et al. Evaluation of a new nanoparticle-based lateral-flow immunoassay for the exclusion of heparin-induced thrombocytopenia (HIT). Thromb Haemost 2011; 106: 1197-1202. Go to original source... Go to PubMed...
  35. Cuker A. Heparin-induced thrombocytopenia (HIT) in 2011: an epidemic of overdiagnosis. Thromb Haemost 2011; 106: 993-994. Go to original source... Go to PubMed...
  36. Bakchoul T, Giptner A, Bein G et al. Performance characteristics of two commercially available IgG-specific immunoassays in the assessment of heparin-induced thrombocytopenia (HIT). Thromb Res 2011; 127: 345-348. Go to original source... Go to PubMed...
  37. Pouplard C, Leroux D, Regina S et al. Effectiveness of a new immunoassay for the diagnosis of heparin-induced thrombocytopenia and improved specificity when detecting IgG antibodies. Thromb Haemost 2010; 103: 145-150. Go to original source... Go to PubMed...
  38. Morel-Kopp MC, Aboud M, Tan CW et al. Whole blood impedance aggregometry detects heparin-induced thrombocytopenia antibodies. Thromb Res 2010; 125: e234-e239. Go to original source... Go to PubMed...
  39. Morel-Kopp MC, Tan CW, Brighton TA et al. ASTH Clinical Trials Group. Validation of whole blood impedance aggregometry as a new diagnostic tool for HIT: results of a large Australian study. Thromb Haemost 2012; 107: 575-583. Go to original source... Go to PubMed...




Vnitřní lékařství

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.