Incidence of antibodies to protamine sulfate/heparin complexes in cardiac surgery patients and impact on platelet activation and clinical outcome
Autor: | Jean Amiral, Yves Gruel, Dorothee Leroux, Jérôme Rollin, Marc-Antoine May, Claire Pouplard |
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Rok vydání: | 2013 |
Předmět: |
Adult
Male 0301 basic medicine Serotonin medicine.medical_specialty Protamine sulfate Adolescent Enzyme-Linked Immunosorbent Assay Coronary Artery Disease 030204 cardiovascular system & hematology Antibodies Young Adult 03 medical and health sciences 0302 clinical medicine Heparin-induced thrombocytopenia medicine Humans Platelet Protamines Platelet activation Cardiac Surgical Procedures Aged Aged 80 and over Cardiopulmonary Bypass biology Heparin business.industry food and beverages Thrombosis Hematology Middle Aged Platelet Activation medicine.disease Thrombocytopenia Protamine Surgery Treatment Outcome 030104 developmental biology biology.protein Female Platelet lysate Peptides business Platelet factor 4 medicine.drug |
Zdroj: | Thrombosis and Haemostasis. 109:1141-1147 |
ISSN: | 2567-689X 0340-6245 |
Popis: | SummaryA new ELISA (Zymutest HIA®), based on incubation of diluted plasma with protamine/heparin (PRT/H) complexes without and with platelet factor 4 (PF4) provided by a platelet lysate, was used to detect heparindependent antibodies in a cohort of 232 cardiac surgery (CS) patients and in 47 patients with heparin-induced thrombocytopenia (HIT). Significant binding of IgG/A/M to PRT/H complexes was demonstrated in 59 CS patients (25.4%), with similar absorbances whether platelet lysate was added to the plasma or not, and significant reactivity to PF4/H in 29 of them. Antibodies to PRT or heparin alone were present in 15 and two of these patients, respectively. Importantly, antibodies to PRT/H were detected in only three of the 47 HIT patients, who had also undergone recent CS. The Zymutest HIA® was positive in another 41 CS patients (17%), but only or mainly when their plasma was tested with platelet lysate, with significant levels of antibodies to PF4/H in 40 of them without detectable reactivity to PRT or heparin alone. Slight antibody binding to PRT/H complexes was also measured in six of these 41 patients. Therefore, a total of 35 CS patients exhibited dual antibody reactivity towards PRT/H and PF4/H complexes. Serotonin release assay performed with PRT alone was positive in 17 CS patients with antibodies to PRT/H, but all had normal platelet count evolution without thrombosis postoperatively. In conclusion, antibodies to PRT/H are frequently present in CS patients postoperatively (25.4%), and can activate platelets in vitro, but their clinical impact remains questionable. |
Databáze: | OpenAIRE |
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