When is HIT Really HIT? The Annals of Thoracic Surgery

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Presentation transcript:

When is HIT Really HIT? The Annals of Thoracic Surgery Theodore E. Warkentin, MD, Mark A. Crowther, MD The Annals of Thoracic Surgery Volume 83, Issue 1, Pages 21-23 (January 2007) DOI: 10.1016/j.athoracsur.2006.07.006 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Iceberg model of heparin-induced thrombocytopenia (HIT). One implication of this model is that there are considerable differences in diagnostic specificity among various laboratory assays to detect HIT antibodies, with the highest specificity seen with the washed platelet activation assays (eg, serotonin-release assay [SRA], heparin-induced platelet activation assay) compared with the PF4/heparin (PF4/H) enzyme-immunoassays (EIAs). The rapid assay, the particle gel immunoassay (PaGIA), appears to have intermediate specificity. Thus, there is the potential to overdiagnose HIT, especially when using relatively nonspecific assays, and when testing a patient population with a high frequency of forming nonpathological antibodies, and with a high frequency of non-HIT explanations for thrombocytopenia. These considerations apply to a ventricular assist device (VAD) population. (IgA = immunoglobulin A; IgG = immunoglobulin G; IgM = immunoglobulin M.) The Annals of Thoracic Surgery 2007 83, 21-23DOI: (10.1016/j.athoracsur.2006.07.006) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Three thrombocytopenic ventricular assist device (VAD) patients. Although all patients have thrombocytopenia and at least two positive tests for anti-PF4/heparin antibodies, the probability that any given patient actually has heparin-induced thrombocytopenia (HIT) differs considerably, ranging from (A) not HIT, to (B) probable HIT, to (C) unlikely HIT. (See also text for further comments.) (+ = positive test; − = negative test; PaGIA = particle gel immunoassay; PF4/H-EIA = PF4/heparin (or PF4/polyanion) enzyme-immunoassay; SRA = serotonin-release assay; VAD = ventricular assist device.) The Annals of Thoracic Surgery 2007 83, 21-23DOI: (10.1016/j.athoracsur.2006.07.006) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions