Utility of ELISA optical density values and clinical scores for the diagnosis of and thrombosis prediction in heparin-induced thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction caused by antibodies to the heparin/platelet factor 4 (PF4) complex, resulting in thrombocytopenia and prothrombotic state. HIT diagnosis is challenging and depends on clinical presentation and laboratory tests. We investigated the u...

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Published in:Annals of laboratory medicine 2011, 31(1), , pp.1-8
Main Authors: Kim, Seon Young, Kim, Hyun Kyung, Han, Kyou Sup, Kim, Inho, Yoon, Sung-Soo, Park, Seonyang, Kim, Byoung Kook
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Antibodies - adverse effects
Antibodies - analysis
Area Under Curve
Child
Child, Preschool
Enzyme-Linked Immunosorbent Assay - methods
Female
Heparin - immunology
Humans
Infant
Male
Middle Aged
Original
Platelet Factor 4 - immunology
Risk
Sensitivity and Specificity
Survival Analysis
Thrombocytopenia - chemically induced
Thrombocytopenia - diagnosis
Thrombocytopenia - mortality
Thrombosis - diagnosis
Thrombosis - etiology
병리학
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creator Kim, Seon Young
Kim, Hyun Kyung
Han, Kyou Sup
Kim, Inho
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Park, Seonyang
Kim, Byoung Kook
description Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction caused by antibodies to the heparin/platelet factor 4 (PF4) complex, resulting in thrombocytopenia and prothrombotic state. HIT diagnosis is challenging and depends on clinical presentation and laboratory tests. We investigated the usefulness of clinical scores and heparin/PF4 ELISA optical density (OD) as a diagnostic marker and thrombosis predictor in HIT. We analyzed 92 patients with suspected HIT. The heparin/PF4 antibody was measured using a commercial ELISA kit (GTI, USA). For each patient, the 4 T's score and Chong's score were calculated. Of the 92 patients, 28 were anti-heparin/PF4-seropositive. The 4 T's score and Chong's score showed good correlation (r=0.874). The 4 T's score and OD values showed good performance for diagnosis of the definite and unlikely HIT groups; however, OD levels showed better sensitivity (93.8%) than the 4 T's score used alone (62.5%). Of the 92 patients, 26 developed thrombosis. The OD values were significantly higher in patients with thrombosis than in those without thrombosis (0.52 vs. 0.22, P0.4) had an increased risk of thrombosis (adjusted odds ratio 9.44 [3.35-26.6], P
doi_str_mv 10.3343/kjlm.2011.31.1.1
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Patients with high OD values (OD&gt;0.4) had an increased risk of thrombosis (adjusted odds ratio 9.44 [3.35-26.6], P&lt;0.001) and a shorter 250-day thrombosis-free survival (32.1% vs. 54.7%, P=0.012). ELISA OD values in combination with clinical scoring can improve the diagnosis of and thrombosis prediction in HIT. 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HIT diagnosis is challenging and depends on clinical presentation and laboratory tests. We investigated the usefulness of clinical scores and heparin/PF4 ELISA optical density (OD) as a diagnostic marker and thrombosis predictor in HIT. We analyzed 92 patients with suspected HIT. The heparin/PF4 antibody was measured using a commercial ELISA kit (GTI, USA). For each patient, the 4 T's score and Chong's score were calculated. Of the 92 patients, 28 were anti-heparin/PF4-seropositive. The 4 T's score and Chong's score showed good correlation (r=0.874). The 4 T's score and OD values showed good performance for diagnosis of the definite and unlikely HIT groups; however, OD levels showed better sensitivity (93.8%) than the 4 T's score used alone (62.5%). Of the 92 patients, 26 developed thrombosis. The OD values were significantly higher in patients with thrombosis than in those without thrombosis (0.52 vs. 0.22, P&lt;0.001). Patients with high OD values (OD&gt;0.4) had an increased risk of thrombosis (adjusted odds ratio 9.44 [3.35-26.6], P&lt;0.001) and a shorter 250-day thrombosis-free survival (32.1% vs. 54.7%, P=0.012). ELISA OD values in combination with clinical scoring can improve the diagnosis of and thrombosis prediction in HIT. More attention should be paid to the use of clinical scores and OD values as thrombosis predictors in HIT.</abstract><cop>Korea (South)</cop><pub>The Korean Society for Laboratory Medicine</pub><pmid>21239863</pmid><doi>10.3343/kjlm.2011.31.1.1</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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2234-3814
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recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3111042
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subjects Adolescent
Adult
Aged
Aged, 80 and over
Antibodies - adverse effects
Antibodies - analysis
Area Under Curve
Child
Child, Preschool
Enzyme-Linked Immunosorbent Assay - methods
Female
Heparin - immunology
Humans
Infant
Male
Middle Aged
Original
Platelet Factor 4 - immunology
Risk
Sensitivity and Specificity
Survival Analysis
Thrombocytopenia - chemically induced
Thrombocytopenia - diagnosis
Thrombocytopenia - mortality
Thrombosis - diagnosis
Thrombosis - etiology
병리학
title Utility of ELISA optical density values and clinical scores for the diagnosis of and thrombosis prediction in heparin-induced thrombocytopenia
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