Five hematologic tests and treatments to question

Hicks, Lisa K.; Bering, Harriet; Carson, Kenneth R.; Haynes, Adam E.; Kleinerman, Judith; Kukreti, Vishal; Alice, D.; Mueller, Brigitta U.; O’Brien, Sarah H.; Pasquini, Marcelo C.; Rajasekhar, Anita; Sarode, Ravindra; Wood, William A.

doi:10.1182/asheducation-2014.1.599

Cited by 12 publications

(5 citation statements)

References 38 publications

(24 reference statements)

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“…The 4 T's score is used for estimating the likelihood of HIT based on readily available clinical features. The score assesses the degree of thrombocytopenia, the timing relative to heparin exposure, the presence of thrombosis, and other causes for thrombocytopenia …”

Section: Discussionmentioning

confidence: 99%

Recurrent heparin‐induced thrombocytopenia due to heparin rinsing before priming the machine in a hemodialysis patient: A case report

Lim

Kang

Lee

et al. 2016

Hemodialysis International

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Heparin has remained the most commonly used anticoagulant for patients undergoing hemodialysis. It is usually safe to use but can have severe adverse effects in some cases. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. It results from an autoantibody directed against endogenous platelet factor 4 (PF4) in complex with heparin, which activates platelets and can cause catastrophic arterial and venous thromboses. Here, we present the case of an 80-year-old woman with a recent diagnosis of chronic renal failure who developed acute HIT (platelet count nadir, 15 × 10 /L) on day 7 of hemodialysis performed with routine heparin anticoagulation, who despite subsequent heparin-free hemodialysis (with argatroban and warfarin) developed recurrent HIT (complicated by acute cerebral infarction) on day 11 that we attributed to "rinsing" of the circuit with heparin-containing saline (3,000 units of unfractionated heparin, with subsequent saline washing) performed pre-dialysis as per routine. After stopping heparin rinsing, the platelet count recovered completely, without further thrombotic or other sequelae. Our experience indicates that for patients with acute HIT, besides the well-known practice of using non-heparin anticoagulation during dialysis and avoiding heparin "locking" of dialysis catheters, it is also important to avoid inadvertent rinsing of the circuit with heparin during preparation for hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Recurrent heparin‐induced thrombocytopenia due to heparin rinsing before priming the machine in a hemodialysis patient: A case report

Lim

Kang

Lee

et al. 2016

Hemodialysis International

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“…These findings indicate that patients with a high clinical suspicion of HIT may benefit from the earlier HIT diagnosis and management facilitated by this assay. Based upon the current and prior evaluations of the LIA, this rapid assay may also be appropriate for patients with moderate and low pretest probability of HIT …”

Section: Discussionmentioning

confidence: 99%

Evaluation of a rapid and automated heparin‐induced thrombocytopenia immunoassay

Refaai

Conley

Ortel

et al. 2019

Int J Lab Hematology

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IntroductionHeparin‐induced thrombocytopenia (HIT) is a potentially life‐threatening adverse reaction of heparin. Laboratory evaluation of HIT is often not available within a reasonable time. We evaluated the HemosIL® HIT‐Ab(PF4‐H) (Instrumentation Laboratory), a rapid, on‐demand, fully automated, latex immunoturbidimetric assay (LIA).Materials and methodsFollowing determination of the LIA's reference interval and cutoff values, a multicenter study was conducted between March 2013 and June 2015. Plasma samples of HIT‐suspected patients (n = 632) were collected and evaluated by LIA on the ACL TOP® Family systems (Instrumentation Laboratory), enzyme‐linked immunosorbent assays (EIA), and serotonin release assay (SRA). Patient characteristics, medical conditions, comorbidities, laboratory results, and medications were collected via medical chart review. The pretest clinical probability of HIT was also calculated for each patient.ResultsBased on the 95% reference interval for healthy donors and HIT‐negative patients, a LIA value ≥1.0 U/mL was interpreted positive. The overall agreement of LIA versus EIA and SRA results were 90% (95% CI 88%‐92%) and 79% (95% CI 75%‐82%), respectively. The negative predictive value for LIA and EIA was comparable (87%) with SRA. The positive and negative percent agreements with the clinical probability were 89% (95% CI 69%‐97%) and 86% (95% CI 83%‐89%), respectively, with a negative predictive value of 99.6% (95% CI 98%‐100%).DiscussionOverall, the LIA results were comparable to those of EIA and SRA. This fully automated assay with a remarkable short analytical turnaround time of <20 minutes can be performed on‐demand, which would greatly facilitate more prompt management of HIT.

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“…Specialty societies recommend a maximum of 3 months of therapeutic anticoagulation for VTE occurring in association with a temporary thrombophilia (Table ); thus, thrombophilia testing in this setting should not be performed as it is not likely to impact long‐term management (Table ). Patients on therapeutic anticoagulation (either oral or parenteral) should not be tested given the potential effects on assay results discussed below, and especially if results of testing will not affect the duration of anticoagulation.…”

Section: Thrombophilia Testing In Venous Thromboembolismmentioning

confidence: 99%

Optimal utilization of thrombophilia testing

Pruthi

2017

Int J Lab Hematology

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The global incidence of venous thromboembolism is high so laboratory testing for hereditary thrombophilia and selected acquired thrombophilia is common. Given the costs associated with testing and multiple pre-analytic and analytic variables affecting the assays, careful patient selection and timing of testing and diligent application to patient management are critical to providing high-value clinical care. Collaboration between the ordering providers and performing laboratories has the potential to achieve these goals. Herein, utility of thrombophilia testing, variables that affect the assays, and impact on patient management are reviewed. Where available, information on cost-effectiveness is discussed.

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Five hematologic tests and treatments to question

Cited by 12 publications

References 38 publications

Recurrent heparin‐induced thrombocytopenia due to heparin rinsing before priming the machine in a hemodialysis patient: A case report

Recurrent heparin‐induced thrombocytopenia due to heparin rinsing before priming the machine in a hemodialysis patient: A case report

Evaluation of a rapid and automated heparin‐induced thrombocytopenia immunoassay

Optimal utilization of thrombophilia testing

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