Usefulness of anti-PF4/heparin antibody test for intensive care unit patients with thrombocytopenia.

The Korean Journal of Hematology Pub Date : 2012-03-01 Epub Date: 2012-03-28 DOI:10.5045/kjh.2012.47.1.39
Sang Hyuk Park, Seongsoo Jang, Hyoeun Shim, Geum-Borae Park, Chan-Jeoung Park, Hyun-Sook Chi, Sang-Bum Hong
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引用次数: 3

Abstract

Background: It is critical to differentiate heparin-induced thrombocytopenia (HIT) from disseminated intravascular coagulation (DIC) in heparinized intensive care unit (ICU) patients with thrombocytopenia because the therapeutic approach differs based on the cause. We investigated the usefulness of PF4/heparin antibody tests in these patients.

Methods: A total of 127 heparinized ICU patients whose platelet counts were <150×10(9)/L or reduced by >50% after 5-10 days of heparin therapy were enrolled. PF4/heparin antibodies were measured using 2 immunoassays. We assessed the probability of HIT by using Warkentin's 4T's scoring system for antibody positive patients and compared routinely performed coagulation test results between patients with and without antibodies to evaluate the ability of these tests to discriminate between HIT and DIC.

Results: Positive results were obtained for 14 (11.0%) and 11 (8.7%) patients in the 2 assays. The analysis performed using the 4T's scoring system revealed that 11 of 20 (15.7%) patients with antibodies in at least 1 assay had intermediate or greater probability of HIT. Patients without antibodies had significantly higher levels of D-dimer than those with antibodies. However, there were no intergroup differences in platelet counts, PT, aPTT, fibrinogen, DIC score, and rate of overt DIC.

Conclusion: Seropositivity for PF4/heparin antibody was 8.7-11.0% in the patients with thrombocytopenia, and more than a half of them had an increased probability of HIT. Among the routine coagulation tests, only D-dimer was informative for differentiating HIT from DIC. PF4/heparin antibody test is useful to ensure appropriate treatment for thrombocytopenic heparinized ICU patients.

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抗pf4 /肝素抗体检测在重症监护病房血小板减少症患者中的应用
背景:在肝素化重症监护病房(ICU)血小板减少患者中,区分肝素诱导的血小板减少症(HIT)和弥散性血管内凝血(DIC)是至关重要的,因为治疗方法根据病因而不同。我们研究了PF4/肝素抗体检测在这些患者中的有效性。方法:选取127例肝素治疗5 ~ 10 d后血小板计数为50%的ICU肝素化患者。采用2种免疫分析法检测PF4/肝素抗体。我们通过使用华肯汀抗体阳性患者的4T评分系统来评估HIT的可能性,并比较有抗体和无抗体患者的常规凝血试验结果,以评估这些试验区分HIT和DIC的能力。结果:2项检测中阳性14例(11.0%),阳性11例(8.7%)。使用4T评分系统进行的分析显示,20例(15.7%)患者中有11例至少在1项检测中有抗体,有中等或更高的HIT概率。无抗体患者的d -二聚体水平明显高于有抗体的患者。然而,在血小板计数、PT、aPTT、纤维蛋白原、DIC评分和显性DIC发生率方面,组间无差异。结论:血小板减少患者血清PF4/肝素抗体阳性率为8.7 ~ 11.0%,半数以上患者HIT发生率增高。在常规凝血试验中,只有d -二聚体可用于区分HIT和DIC。PF4/肝素抗体检测有助于确保血小板减减性肝素化ICU患者的适当治疗。
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