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CC BY-NC-ND 4.0 · TH Open 2021; 05(04): e507-e512
DOI: 10.1055/a-1653-5065
Original Article

Heparin-induced Thrombocytopenia Diagnosis: A Retrospective Study Comparing Heparin-induced Platelet Activation Test to 14C-serotonin Release Assay

Marie-Caroline Gonthier‡   *
1   Laboratory of Vascular Translational Science, Université de Paris, INSERM, et Laboratoire d'Hématologie, AH-HP, Bichat–Claude Bernard Hospital, Paris, France
,
Nicolas Gendron  ‡   *
1   Laboratory of Vascular Translational Science, Université de Paris, INSERM, et Laboratoire d'Hématologie, AH-HP, Bichat–Claude Bernard Hospital, Paris, France
2   Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Paris, France
,
Philippine Eloy
3   Département d'Epidémiologie, Biostatistique et Recherche Clinique, AH-HP, Bichat–Claude Bernard Hospital, Paris, France
,
Marie-Charlotte Bourrienne 
1   Laboratory of Vascular Translational Science, Université de Paris, INSERM, et Laboratoire d'Hématologie, AH-HP, Bichat–Claude Bernard Hospital, Paris, France
,
Martine Alhenc-Gelas
2   Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Paris, France
,
Claire Pouplard
4   CHRU Tours, Service d'hématologie-hémostase, Université de Tours, Tours, France
,
Bernard Tardy
5   Inserm CIC 1408 CHU Saint Etienne, Saint-Etienne, France
,
Jean Szymezak
6   Laboratoire d'hématologie, CHU Robert Debré, Reims, France
,
Charles Burdet
3   Département d'Epidémiologie, Biostatistique et Recherche Clinique, AH-HP, Bichat–Claude Bernard Hospital, Paris, France
7   Université de Paris, IAME, INSERM, Paris, France
,
Vasiliki Gkalea
1   Laboratory of Vascular Translational Science, Université de Paris, INSERM, et Laboratoire d'Hématologie, AH-HP, Bichat–Claude Bernard Hospital, Paris, France
,
Dorothée Faille
1   Laboratory of Vascular Translational Science, Université de Paris, INSERM, et Laboratoire d'Hématologie, AH-HP, Bichat–Claude Bernard Hospital, Paris, France
,
Nadine Ajzenberg
1   Laboratory of Vascular Translational Science, Université de Paris, INSERM, et Laboratoire d'Hématologie, AH-HP, Bichat–Claude Bernard Hospital, Paris, France
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Abstract

Laboratory confirmation of heparin-induced thrombocytopenia (HIT) is of crucial importance and remains challenging and relies on platelet functional assays highlighting the presence of heparin-dependent platelet-activating antibodies in patient serum or plasma. Platelet functional assays using washed platelets include the 14C-serotonin release assay (SRA), usually described as the gold standard, and the heparin-induced platelet activation assay (HIPA). Since its first comparison with SRA there has been no additional published study regarding HIPA diagnostic performances compared with SRA. Aim of our retrospective study was to compare the concordance between HIPA and SRA in HIT suspected-patients with positive anti-PF4/heparin antibodies between October 2010 and October 2015. Fifty-five HIT-suspected patients who beneficiated from both HIPA and SRA were included. Positive and negative percent agreements were 83.8% (95% CI 68.0–93.8%) and 66.7% (95% CI 41.0–86.7%), respectively. Overall percent agreement was 78.2% (95% CI 65.0–92.2%). Agreement was higher in patients who underwent cardiopulmonary bypass with extracorporeal circulation circuit for cardiac surgery. We also confirm that the use of a minimum of 2 platelet donors to establish positive HIT diagnosis and 4 platelet donors to exclude HIT diagnosis allows obtaining a good agreement with SRA. Although HIPA and SRA were performed with different platelet donors and in different laboratories, HIPA had a good positive agreement with SRA for HIT diagnosis, showing that HIPA is a useful functional assay that does not require radioactivity and could be developed worldwide to improve HIT diagnosis.

Keywords

heparin-induced thrombocytopenia - heparin induced platelet activation test - 14C-serotonin release assay - PF4/heparin antibodies - laboratory diagnosis

Author Contributions

CΓ, NG, MCB, MAG, CP, BT, JS, DF and NA performed the research


CG, DF and NA designed the research study


NG, PE, CB, VG, DF and NA analyzed the data


NG, VG, DF and NA wrote the paper.


Disclosures

Authors do not have any conflict of interest to declare.


* These two authors contributed equally to the work




Publication History

Received: 27 July 2021

Accepted: 08 September 2021

Accepted Manuscript online:
24 September 2021

Article published online:
09 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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