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IgG classification of anti-PF4/heparin antibodies to identify patients with heparin-induced thrombocytopenia during mechanical circulatory support.
- Article/chapterEnglish2007
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Elsevier BV,2007
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printrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:uu-161358
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-161358URI
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https://doi.org/10.1111/j.1538-7836.2007.02295.xDOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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Commercial immunoassays frequently detect anti-PF4/heparin antibodies during mechanical circulatory support (MCS), but only a small minority of patients develops heparin-induced thrombocytopenia (HIT). Whereas platelet functional tests can distinguish between platelet-activating and non-platelet-activating antibodies, commercial PF4-dependent immunoassays do not. Between 2003 and 2004, 113 patients were placed on MCS. Blood samples were obtained on postimplant day 5-7 for analyses by antibody assays and the functional heparin-induced platelet activation (HIPA) assay. Three distinct groups of patient sera were identified: platelet-activating anti-PF4/heparin antibodies (n = 10), non-platelet-activating anti-PF4/heparin antibodies (n = 53), and anti-PF4/heparin antibody negative (n = 50). Patients with platelet-activating antibodies had the highest risk for thromboembolic events (P < 0.005), whereas those with non-platelet-activating antibodies did not differ from antibody negative patients (P = 0.369). The enzyme-immunoassay and column agglutination assays, which cover all immunoglobulin classes, demonstrated adequate sensitivity and negative predictive value; yet, both lacked specificity with respect to the platelet-activating antibodies. If all antibody positive patients were further classified by an IgG-specific anti-PF4/heparin enzyme-immuno assay, specificity for platelet-activating antibodies increased. Whereas IgG-specific optical density (OD) values below 1.0 were likely for non-platelet-activating anti-PF4/heparin antibodies, higher values were progressively predictive for pathogenic platelet activation. The probability of the development of clinical HIT also increased steeply. In conclusion, platelet-activating anti-PF4/heparin antibodies are relatively common (about 9%) in patients on MCS and are associated with significantly higher thrombotic event rates. Low IgG-specific OD values (< 1.0) in the enzyme-immunoassay indicate low likelihood for the presence of platelet-activating antibodies. These results justify further validation so that anticoagulation during MCS becomes safer and adequate.
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El-Banayosy, A
(author)
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Morshuis, M
(author)
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Arusoglu, L
(author)
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Eichler, P
(author)
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Lubenow, NorbertDepartment of Transfusion Medicine, Greifswald University, Germany(Swepub:uu)norlu522
(author)
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Tenderich, G
(author)
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Koerfer, R
(author)
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Greinacher, A
(author)
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Prohaska, W
(author)
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Department of Transfusion Medicine, Greifswald University, Germany
(creator_code:org_t)
Related titles
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In:Journal of Thrombosis and Haemostasis: Elsevier BV5:2, s. 235-411538-79331538-7836
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Schenk, S
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El-Banayosy, A
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Morshuis, M
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Arusoglu, L
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Eichler, P
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Lubenow, Norbert
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show more...
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Tenderich, G
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Koerfer, R
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Greinacher, A
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Prohaska, W
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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Journal of Throm ...
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Uppsala University