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A diagnostic test for heparin-induced thrombocytopenia
D Sheridan, C Carter and JG Kelton
Heparin-induced thrombocytopenia can be a serious and difficult-to-
diagnose complication of heparin therapy. Serum from patients with
heparin-induced thrombocytopenia can cause heparin-dependent platelet
aggregation, but the low sensitivity and specificity of this test limit its
clinical usefulness. In this report we describe an assay for
heparin-induced thrombocytopenia that is both sensitive and specific. The
improvement in the assay was accomplished by measuring platelet release
instead of aggregation and by measuring platelet release at two heparin
concentrations. The rationale for the use of two heparin concentrations was
that sera from patients with heparin-induced thrombocytopenia caused
release at therapeutic but not at high concentrations of heparin.
Twenty-eight sera samples from patients suspected of having heparin-induced
thrombocytopenia and 573 controls were coded and tested in the assay. The
patients with possible heparin- induced thrombocytopenia were ranked
according to the likelihood of having this disorder by using prospectively
defined criteria. The test had a high specificity (99%); only one of 573
controls showed a positive result. The test was also very sensitive, and
the likelihood of a positive test result was directly correlated with the
clinical likelihood of the patient having heparin-induced thrombocytopenia.
Six of six patients with definitive heparin-induced thrombocytopenia had
positive test results, whereas zero of four patients in whom the diagnosis
was unlikely had positive test results. The two-point test for
heparin-induced thrombocytopenia represents a sensitive and specific test
for this disorder. This test may be useful not only in confirming the
diagnosis of this disorder but also may provide information about its
pathogenesis.
Volume 67,
Issue 1,
pp. 27-30,
01/01/1986
Copyright © 1986 by The American Society of Hematology
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