title: Functional Assays in the Diagnosis of Heparin-Induced Thrombocytopenia: A Review.
abstract: A rapid and accurate diagnosis in patients with suspected heparin-induced thrombocytopenia (HIT) is essential for patient management but remains challenging. Current HIT diagnosis ideally relies on a combination of clinical information, immunoassay and functional assay results. Platelet activation assays or functional assays detect HIT antibodies that are more clinically significant. Several functional assays have been developed and evaluated in the literature. They differ in the activation endpoint studied; the technique or technology used; the platelet donor selection; the platelet suspension (washed platelets, platelet rich plasma or whole blood); the patient sample (serum or plasma); and the heparin used (type and concentrations). Inconsistencies in controls performed and associated results interpretation are common. Thresholds and performances are determined differently among papers. Functional assays suffer from interlaboratory variability. This lack of standardization limits the evaluation and the accessibility of functional assays in laboratories. In the present article, we review all the current activation endpoints, techniques and methodologies of functional assays developed for HIT diagnosis.
authors.affiliation: Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur 5000, Belgium. valentine.minet@unamur.be.
authors.forename: Valentine
authors.initials: V
authors.lastname: Minet
authors.affiliation: Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur 5000, Belgium. jean-michel.dogne@unamur.be.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Dogné
authors.affiliation: CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Hematology Laboratory, Université catholique de Louvain, Yvoir 5530, Belgium. ois@gmail.com.
authors.forename: François
authors.initials: F
authors.lastname: Mullier
mesh_terms: D001777:Blood Coagulation / Q000187:drug effects; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D015539:Platelet Activation / Q000187:drug effects; D010979:Platelet Function Tests / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control
chemical_list: D006493:Heparin
keywords: diagnosis; functional assay; heparin-induced thrombocytopenia; platelets