Anti-heparin/PF4 complexes by ELISA in patients with disseminated intravascular coagulation.
Heparin-induced thrombocytopenia (HIT) is known to complicate disseminated intravascular coagulation (DIC), but rarely to be complicated by DIC. We measured the titers of anti-PF4/hepatin complex antibodies by ELISA (HIT-Elisa) and examined 4 parameters of coagulation and fibrinolysis [D-dimer, thrombin/antithrombin complex (TAT), plasmin/alpha2-plasmin inhibitor complex (PIC), and antithrombin levels] in 80 patients with DIC diagnosed by a DIC scoring system. Fourteen patients were HIT-Elisa-positive, 11 of whom received heparin. In 3 of these 11 patients, platelet counts were < or =10 x 10(9)/l and/or reduced by more than 50% for 5-10 days after the heparin (2 patients treated with renal replacement therapy for chronic uremia and postoperative renal failure, and 1 with DIC from a solid tumor). The 3 patients had an optical density reading of >1.0 and a high level of IgG for HIT antibodies, and were thus considered to have DIC complicated with HIT (DIC-HIT). The other 8 patients had optical density readings of 0.4-1.0, and it was unclear whether their thrombocytopenia was caused by HIT alone or by sustained DIC. There were no significant differences in platelet counts and the 4 parameters of coagulation and fibrinolysis between the patients with DIC-HIT and DIC patients with a weakly positive result (0.4-1.0). No differences were observed in platelet counts, or levels of D-dimer and antithrombin between HIT-Elisa-positive and -negative DIC patients. However, the HIT-Elisa-negative patients showed significantly higher levels of TAT and PIC, presumably reflecting DIC-related hypercoagulability. In conclusion, DIC patients treated with heparin occasionally showed HIT antibody seroconversion and developed HIT. HIT-Elisa could assist in the diagnosis of HIT.
Hyogo Prefectural Awaji Hospital, Sumoto, Japan. hit-center@mbn.nifty.com
Takefumi
T
Matsuo
Miyako
M
Matsuo
Takaki
T
Sugimoto
Keiko
K
Wanaka
D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D001777:Blood Coagulation / Q000502:physiology; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000150:complications / Q000175:diagnosis; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005341:Fibrinolysin / Q000378:metabolism; D005342:Fibrinolysis / Q000502:physiology; D006493:Heparin / Q000097:blood; D006801:Humans; D008297:Male; D010447:Peptide Hydrolases / Q000097:blood; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000097:blood / Q000276:immunology*; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications / Q000175:diagnosis
D001323:Autoantibodies; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; D010978:Platelet Factor 4; D000990:Antithrombin III; D006493:Heparin; D010447:Peptide Hydrolases; D005341:Fibrinolysin