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Platelet factor 4/heparin-particle gel immunoassay (PaGIA) is a weak method for heparin-induced thrombocytopenia (HIT) evaluation of post cardio-pulmonary bypass surgery patients

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Abstract

Diagnosis of heparin induced thrombocytopenia (HIT) is not always easy, especially when a confirmatory functional test is not available. In most cases the diagnosis relies on the combination of pretest probability and an immunologic test. Among patients post cardiopulmonary bypass (CPB) surgery, anti-platelet factor 4/heparin antibodies tend to be high but with low clinical implication. The current retrospective study examined the behavior of patients with positive PF4/heparin-PaGIA results, divided into two groups according to whether or not they have undergone CPB surgery. The main focus of the study was on the reliability of the PF4/heparin-PaGIA test in these two settings. The files of 104 single center patients, who had a positive PF4/heparin-PaGIA test, were reviewed. 62 % were post CPB and 38 % were not. An association between the intensity of positivity of PF4/heparin-PaGIA test and both the 4Ts pretest probability method (p = 0.003) and the incidence of thrombosis (p = 0.02) was found only in the patients who have not undergone CPB surgery, but not in the CPB patients. This study suggests that PF4/heparin-PaGIA is not a reliable method in patients post CPB surgery who are investigated for a possible diagnosis of HIT.

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Authors and Affiliations

  1. Department of Hematology, Shaare Zedek Medical Center, P.O.B. 3235, 91031, Jerusalem, Israel

    Chezi Ganzel, Jacob Rowe & David Raveh

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  1. Chezi Ganzel
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  2. Jacob Rowe
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  3. David Raveh
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Correspondence to Chezi Ganzel.

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Ganzel, C., Rowe, J. & Raveh, D. Platelet factor 4/heparin-particle gel immunoassay (PaGIA) is a weak method for heparin-induced thrombocytopenia (HIT) evaluation of post cardio-pulmonary bypass surgery patients. J Thromb Thrombolysis 38, 314–320 (2014). https://doi.org/10.1007/s11239-014-1066-5

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  • DOI: https://doi.org/10.1007/s11239-014-1066-5

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