Rapid exclusion of the diagnosis of immune HIT by AcuStar HIT and heparin-induced multiple electrode aggregometry.
BACKGROUND
Accurate diagnosis of heparin-induced thrombocytopenia (HIT) is essential but remains challenging. We have previously demonstrated, in a retrospective study, the usefulness of the combination of the 4Ts score, AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) with optimized thresholds.


OBJECTIVE
We aimed at exploring prospectively the performances of our optimized diagnostic algorithm on suspected HIT patients. The secondary objective is to evaluate performances of AcuStar HIT-Ab (PF4-H) in comparison with the clinical outcome.


METHODS
116 inpatients with clinically suspected immune HIT were included. Our optimized diagnostic algorithm was applied to each patient. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) of the overall diagnostic strategy as well as AcuStar HIT-Ab (at manufacturer's thresholds and at our thresholds) were calculated using clinical diagnosis as the reference.


RESULTS
Among 116 patients, 2 patients had clinically-diagnosed HIT. These 2 patients were positive on AcuStar HIT-Ab, AcuStar HIT-IgG and HIMEA. Using our optimized algorithm, all patients were correctly diagnosed. AcuStar HIT-Ab at our cut-off (>9.41 U/mL) and at manufacturer's cut-off (>1.00 U/mL) showed both a sensitivity of 100.0% and a specificity of 99.1% and 90.4%, respectively.


CONCLUSIONS
The combination of the 4Ts score, the HemosIL® AcuStar HIT and HIMEA with optimized thresholds may be useful for the rapid and accurate exclusion of the diagnosis of immune HIT.
Department of Pharmacy, Namur Thrombosis Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium. Electronic address: valentine.minet@unamur.be.
V
V
Minet
Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), CHU Dinant Godinne - UCL Namur, Belgium.
J
J
Baudar
Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), CHU Dinant Godinne - UCL Namur, Belgium.
N
N
Bailly
Department of Pharmacy, Namur Thrombosis Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium.
J
J
Douxfils
Department of Pharmacy, Namur Thrombosis Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium.
J
J
Laloy
Anesthesiology Department, Namur Thrombosis and Hemostasis Center (NTHC), CHU Dinant Godinne - UCL Namur, Belgium.
S
S
Lessire
Anesthesiology Department, Namur Thrombosis and Hemostasis Center (NTHC), CHU Dinant Godinne - UCL Namur, Belgium.
M
M
Gourdin
Hematology Department, Namur Thrombosis Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), CHU Dinant Godinne - UCL Namur, Belgium.
B
B
Devalet
Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), CHU Dinant Godinne - UCL Namur, Belgium.
B
B
Chatelain
Department of Pharmacy, Namur Thrombosis Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium.
J M
JM
Dogné
Department of Pharmacy, Namur Thrombosis Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium; Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), CHU Dinant Godinne - UCL Namur, Belgium.
F
F
Mullier
D000925:Anticoagulants / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010974:Platelet Aggregation / Q000187:drug effects; D010979:Platelet Function Tests; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis* / Q000276:immunology
D000925:Anticoagulants; D006493:Heparin
HemosIL AcuStar HIT; heparin-induced multiple electrode aggregometry; immune heparin-induced thrombocytopenia