Severe persistent heparin-induced thrombocytopenia in a renal transplant patient

Chawla, Divya; Saad, Ehab; Khairi, Talal; Padmanabhan, Anand

doi:10.1016/j.thromres.2019.10.014

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…Consistent with prior studies, P-selectin expression was higher in the PEA relative to other versions of the assay using lower concentrations of PF4 that create fewer HIT antigen sites. 15,25 Based on the results of this study, it may be concluded that the PEA variants performed with lower amounts of PF4 do not seem to provide additional diagnostic utility beyond that offered by the standard PEA. Our results also confirm the presence of the recently described entity of SRA 2 HIT, 11,26,27 wherein samples from bona fide HIT patients are negative in the SRA but are positive in novel assays that use PF4-treated platelets, such as the PF4 SRA and the PEA.…”

Section: Discussionmentioning

confidence: 79%

A prospective, blinded study of a PF4-dependent assay for HIT diagnosis

Bannow

Warad

Jones³

et al. 2021

Blood

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Heparin-induced thrombocytopenia (HIT) is a life-threatening, pro-thrombotic, antibody-mediated disorder. To maximize the likelihood of recovery, early and accurate diagnosis is critical. Widely available HIT assays such as the Platelet Factor 4-Heparin ELISAs lack specificity, and the "gold standard" C14-labeled serotonin release assay (SRA) is of limited value for early patient management due to availability only through reference laboratories. Recent studies demonstrate that "pathogenic" HIT antibodies selectively activate PF4-treated platelets and that a technically simpler assay, the PF4-dependent P-selectin Expression Assay (PEA), may provide an option for rapid and conclusive results. Four hundred and nine consecutive adults suspected of HIT were classified as disease-positive, -negative or -indeterminate based upon predefined criteria that combined 4Ts scores and HIT ELISA results. Patients deemed "HIT-indeterminate" were considered disease-negative in the primary analysis and disease-positive in a sensitivity analysis. The ability of PEA and SRA to identify patients judged to have HIT was compared using receiver operating characteristic curve statistics. Using these predefined criteria, the diagnostic accuracy of PEA was high (Area under the curve [AUC] of 0.94; 0.87-1.0, 95% CI) and similar to that of SRA (0.91; 0.82-1.0, 95% CI). In sensitivity analysis, the AUCs of PEA and SRA were also similar at 0.88 (0.78-0.98, 95% CI) and 0.86 (0.77-0.96, 95% CI), respectively. The PEA, a technically simple non-radioactive assay that uses ~20-fold fewer platelets compared to the SRA had high accuracy for diagnosing HIT. Widespread use of the PEA may facilitate timely and more effective management of patients with suspected HIT.

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Section: Discussionmentioning

confidence: 79%

A prospective, blinded study of a PF4-dependent assay for HIT diagnosis

Bannow

Warad

Jones³

et al. 2021

Blood

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“…It seems unlikely that the administration of this antibiotic would harm the donor, except on the very rare case that the donor has a severe allergy to doxycycline. Also, the administration of doxycycline prior to cardiac arrest would undoubtedly represent a lower risk than the administration of intravenous heparin in high doses, a common practice in many centers that participate in DCDD donation [229]. The administration of doxycycline prior to cardiac arrest might help improve the quality of not only kidneys, but also the heart, lungs, liver, pancreas, and small bowel as well [230].…”

Section: Organ Transplant and Ischemiamentioning

confidence: 99%

Mitochondria and Antibiotics: For Good or for Evil?

et al. 2021

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The discovery and application of antibiotics in the common clinical practice has undeniably been one of the major medical advances in our times. Their use meant a drastic drop in infectious diseases-related mortality and contributed to prolonging human life expectancy worldwide. Nevertheless, antibiotics are considered by many a double-edged sword. Their extensive use in the past few years has given rise to a global problem: antibiotic resistance. This factor and the increasing evidence that a wide range of antibiotics can damage mammalian mitochondria, have driven a significant sector of the medical and scientific communities to advise against the use of antibiotics for purposes other to treating severe infections. Notwithstanding, a notorious number of recent studies support the use of these drugs to treat very diverse conditions, ranging from cancer to neurodegenerative or mitochondrial diseases. In this context, there is great controversy on whether the risks associated to antibiotics outweigh their promising beneficial features. The aim of this review is to provide insight in the topic, purpose for which the most relevant findings regarding antibiotic therapies have been discussed.

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“…However, this may differ based on the patient population, type of heparin product used and the duration of heparin use 2. In transplant patients, HIT appears to be relatively rare, with cardiothoracic transplants having the highest risk 3–6. To date, only a handful of case reports or studies exist for patients with HIT after liver transplantation 3…”

Section: Introductionmentioning

confidence: 99%

Using novel PF4-dependent P-selectin expression assay to diagnose heparin-induced thrombocytopaenia postliver transplantation

et al. 2022

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Heparin-induced thrombocytopaenia (HIT) is a well-known adverse event associated with the use of heparin products. HIT may be difficult to diagnose in patients following liver transplantation as patients routinely require massive transfusion support and immunosuppression. As an alternative or adjunctive to the serotonin release assay, the PF4-dependent P-selectin expression assay (PEA) may be a useful diagnostic test in the determination of HIT in this patient population. In this case, we describe a 63-year-old man who had an orthotopic liver transplant that was complicated by HIT that was diagnosed using the PEA.

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Severe persistent heparin-induced thrombocytopenia in a renal transplant patient

Cited by 4 publications

References 10 publications

A prospective, blinded study of a PF4-dependent assay for HIT diagnosis

A prospective, blinded study of a PF4-dependent assay for HIT diagnosis

Mitochondria and Antibiotics: For Good or for Evil?

Using novel PF4-dependent P-selectin expression assay to diagnose heparin-induced thrombocytopaenia postliver transplantation

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