title: Urgent cardiac surgery in a patient with a remote history of heparin-induced thrombocytopenia: use of the anti-PF4/heparin ELISA confirmatory test.
abstract: The use of established heparin protocols when heparin-induced thrombocytopenia (HIT) antibodies are negative is currently recommended for the management of patients with previous HIT who require cardiac surgery. Routine preoperative testing for HIT antibodies using an anti-PF4/heparin enzyme-linked immunosorbent assay (ELISA) introduces the problem of detecting nonpathogenic HIT antibodies, which can lead to a false diagnosis of the presence of platelet-activating antibodies. Our case report demonstrates the clinical utility of a newer confirmatory procedure performed using high dose heparin. We use this procedure in situations in which pretest probability is low (remote HIT) and the anti-PF4/heparin ELISA test results are weak to moderately positive (absorbance 0.4-1.0).
authors.affiliation: Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, Texas 75390-9202, USA. suzanne.dellaria@utsouthwestern.edu
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Dellaria
authors.forename: Philip E
authors.initials: PE
authors.lastname: Greilich
authors.forename: Ravindra
authors.initials: R
authors.lastname: Sarode
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000276:immunology; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004630:Emergencies; D004797:Enzyme-Linked Immunosorbent Assay; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010978:Platelet Factor 4 / Q000276:immunology*; D012680:Sensitivity and Specificity; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology
chemical_list: D000925:Anticoagulants; D010978:Platelet Factor 4; D006493:Heparin