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The utility of pre‐test clinical scoring for clinical diagnosis of heparin‐induced thrombocytopenia in cardiac surgery patients of a tertiary care centre in North India
Author(s) -
Sachan D.,
Gupta N.,
Agarwal P.,
Chaudhary R.
Publication year - 2011
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/j.1365-3148.2010.01068.x
Subject(s) - heparin induced thrombocytopenia , tertiary care , medicine , heparin , cardiac surgery , test (biology) , intensive care medicine , surgery , paleontology , biology
Background: Heparin‐induced thrombocytopenia (HIT) should be diagnosed clinically as well as by laboratory assays for timely recognition, prevention and management of complications. Objective: To evaluate the clinical utility of pre‐test clinical scoring system in combination with two immunoassays for the diagnosis of HIT in cardiac surgery patients. Materials and methods: A total of 100 consecutive patients undergoing cardiac surgery were studied. Pre‐test clinical scoring was carried out in patients with thrombocytopenia and further tested by two immunoassays, i.e. Heparin platelet factor 4 (H‐PF4) enzyme‐linked immunosorbent assay (ELISA) and particle gel immunoassay (PaGIA). Results: Of the 100 patients studied, 42 patients developed thrombocytopenia post‐operatively. On pre‐test clinical scoring, low T ‐score was observed in 6 patients, intermediate in 28 and high score in 8 patients, whereas 19 patients (45·2%) were positive by H‐PF4 ELISA and 10 (23·8%) by PaGIA for H‐PF4 antibody. The difference in the incidence of clinically significant HIT antibodies in the three categories was statistically significant. A good correlation was also observed with ELISA optical density, T ‐scoring and PaGIA. Conclusions: Pre‐test clinical scoring correlates well with the development of H‐PF4 antibodies which are incriminated in the causation of thrombotic complications in patients with HIT. We also propose a protocol for diagnosing patients with clinical suspicion of HIT using pre‐test clinical scoring and immunoassay.