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Title: | A multicentre assessment of contemporary laboratory assays for heparin induced thrombocytopenia. | Authors: | Motum P.;Brighton T.;Tan C.W.;Favaloro E.J.;Mohammed S.;Donikian D.;Kondo M.;Duncan E.;Yacoub O.;Zebeljan D.;Ng S.;Malan E.;Yuen A.;Beggs J.;Moosavi S.;Coleman R.;Klose N.;Chapman K.;Cavanaugh L.;Pasalic L. | Institution: | (Favaloro, Mohammed, Pasalic) Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia (Favaloro, Mohammed, Donikian, Kondo, Zebeljan, Ng, Chapman, Cavanaugh, Pasalic, Motum, Brighton) NSW Health Pathology, NSW, Australia (Favaloro, Pasalic) School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia (Donikian, Kondo, Brighton) Prince of Wales Hospital, Randwick, NSW, Australia (Duncan, Yacoub, Tan) South Australia Pathology, Adelaide, SA, Australia (Zebeljan, Ng, Motum) Liverpool Hospital, Liverpool, NSW, Australia (Malan, Yuen) Monash Health, Melbourne, Vic, Australia (Beggs, Moosavi) Queensland Health, Brisbane, Qld, Australia (Coleman, Klose) Sullivan Nicolaides Pathology, Brisbane, Qld, Australia (Chapman) John Hunter Hospital, Newcastle, NSW, Australia (Cavanaugh) St George Hospital, Kogarah, NSW, Australia (Tan) Royal Adelaide Hospital, Adelaide, SA, Australia | Issue Date: | 24-Apr-2021 | Copyright year: | 2021 | Publisher: | Elsevier B.V. | Place of publication: | United States | Publication information: | Pathology. 53 (2) (pp 247-256), 2021. Date of Publication: February 2021. | Journal: | Pathology | Abstract: | Heparin induced thrombocytopenia (HIT) is a rare but potentially fatal complication of heparin therapy. In some patients, HIT causes platelet activation and thrombosis (sometimes abbreviated HITT), which leads to adverse clinical sequalae ('pathological HIT'). The likelihood of HIT is initially assessed clinically, typically using a scoring system, of which the 4T score is that most utilised. Subsequent laboratory testing to confirm or exclude HIT facilitates exclusion or diagnosis and management. The current investigation comprises a multicentre (n=9) assessment of contemporary laboratory testing for HIT, as performed over the past 1-3 years in each site and comprising testing of over 1200 samples. The primary laboratory test used by study participants (n=8) comprised a chemiluminescence procedure (HIT-IgG(PF4-H)) performed on an AcuStar instrument. Additional immunological testing performed by study sites included lateral flow (STiC, Stago), enzyme linked immunosorbent assay (ELISA), Asserachrom (HPIA IgG), PaGIA (BioRad), plus functional assays, primarily serotonin release assay (SRA) or platelet aggregation methods. The chemiluminescence procedure yielded a highly sensitive screening method for identifying functional HIT, given high area under the curve (AUC, generally >=0.9) in a receiver operator characteristic (ROC) analysis against SRA as gold standard. ELISA testing resulted in lower ROC AUC scores (<0.8) and higher levels of false positives. Although there is clear association with the likelihood of HIT, the 4T score had less utility than literature suggests, and was comparable to a previous study reported by some of the authors.Copyright © 2020 | DOI: | http://monash.idm.oclc.org/login?url= http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/j.pathol.2020.07.012 |
PubMed URL: | 33032809 [http://www.ncbi.nlm.nih.gov/pubmed/?term=33032809] | ISSN: | 0031-3025 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/26576 | Type: | Article | Subjects: | clinical assessment adult article chemoluminescence controlled study drug megadose enzyme linked immunosorbent assay female functional assessment *heparin induced thrombocytopenia/di [Diagnosis] human laboratory test low drug dose major clinical study male multicenter study platelet aggregation assay priority journal prospective study thrombocyte aggregation heparin ELISA kit *hemostasis testing system PaGIA low drug dose major clinical study male multicenter study platelet aggregation assay priority journal prospective study chemoluminescence Article adult thrombocyte aggregation clinical assessment controlled study drug megadose enzyme linked immunosorbent assay female functional assessment *heparin induced thrombocytopenia / *diagnosis human laboratory test |
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