Plasma exchange to remove HIT antibodies: dissociation between enzyme-immunoassay and platelet activation test reactivities
| Autor: | F. Victor Chu, Anil Kapoor, Theodore E. Warkentin, Mark Crowther, Azim S. Gangji, Jo-Ann I. Sheppard |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Blood Platelets
Immunology Hemorrhage Vena Cava Inferior Platelet Factor 4 Biochemistry Serology Immunoenzyme Techniques medicine Humans Platelet In patient Platelet activation Aged chemistry.chemical_classification medicine.diagnostic_test biology Plasma Exchange business.industry Heparin Carcinoma Thrombosis Cell Biology Hematology Platelet Activation Thrombocytopenia Kidney Neoplasms Enzyme Treatment Outcome chemistry Immunoassay Immunoglobulin G biology.protein Female Antibody business medicine.drug |
| Zdroj: | Blood. 125(1) |
| ISSN: | 1528-0020 |
| Popis: | Repeated therapeutic plasma exchange (TPE) has been advocated to remove heparin-induced thrombocytopenia (HIT) IgG antibodies before cardiac/vascular surgery in patients who have serologically-confirmed acute or subacute HIT; for this situation, a negative platelet activation assay (eg, platelet serotonin-release assay [SRA]) has been recommended as the target serological end point to permit safe surgery. We compared reactivities in the SRA and an anti-PF4/heparin IgG-specific enzyme immunoassay (EIA), testing serial serum samples in a patient with recent (subacute) HIT who underwent serial TPE precardiac surgery, as well as for 15 other serially-diluted HIT sera. We observed that post-TPE/diluted HIT sera-when first testing SRA-negative-continue to test strongly positive by EIA-IgG. This dissociation between the platelet activation assay and a PF4-dependent immunoassay for HIT antibodies indicates that patients with subacute HIT undergoing repeated TPE before heparin reexposure should be tested by serial platelet activation assays even when their EIAs remain strongly positive. |
| Databáze: | OpenAIRE |
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