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Khan NZ, Chen LY, Lindenbauer A, Pliquett U, Rothe H, Nguyen TH. Label-Free Detection and Characterization of Heparin-Induced Thrombocytopenia (HIT)-like Antibodies. ACS OMEGA 2021; 6:25926-25939. [PMID: 34660955 PMCID: PMC8515375 DOI: 10.1021/acsomega.1c02496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/16/2021] [Indexed: 05/04/2023]
Abstract
Heparin-induced thrombocytopenia (HIT) antibodies (Abs) can mediate and activate blood cells, forming blood clots. To detect HIT Abs, immunological assays with high sensitivity (≥95%) and fast response are widely used, but only about 50% of these tests are accurate as non-HIT Abs also bind to the same antigens. We aim to develop biosensor-based electrical detection to better differentiate HIT-like from non-HIT-like Abs. As a proof of principle, we tested with two types of commercially available monoclonal Abs including KKO (inducing HIT) and RTO (noninducing HIT). Platelet factor 4/Heparin antigens were immobilized on gold electrodes, and binding of antibodies on the chips was detected based on the change in the charge transfer resistance (R ct). Binding of KKO on sensors yielded a significantly lower charge transfer resistance than that of RTO. Bound antibodies and their binding characteristics on the sensors were confirmed and characterized by complementary techniques. Analysis of thermal kinetics showed that RTO bonds are more stable than those of KKO, whereas KKO exhibited a higher negative ζ potential than RTO. These different characteristics made it possible to electrically differentiate these two types of antibodies. Our study opens a new avenue for the development of sensors for better detection of pathogenic Abs in HIT patients.
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Affiliation(s)
- Nida Zaman Khan
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
- Institute
for Chemistry and Biotechnology, Faculty of Mathematics and Natural
Sciences, Technische Universität
Ilmenau, 98694 Ilmenau, Germany
| | - Li-Yu Chen
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
- Institute
of Microbiology, Friedrich Schiller University, 07745 Jena, Germany
| | - Annerose Lindenbauer
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
| | - Uwe Pliquett
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
| | - Holger Rothe
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
| | - Thi-Huong Nguyen
- Institute
for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heiligenstadt, Germany
- Institute
for Chemistry and Biotechnology, Faculty of Mathematics and Natural
Sciences, Technische Universität
Ilmenau, 98694 Ilmenau, Germany
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Jousselme E, Guéry EA, Nougier C, Sobas F, Rollin J, Gruel Y, Vayne C, Pouplard C. Prospective evaluation of two specific IgG immunoassays (HemosIL ® AcuStar HIT-IgG and HAT45G ® ) for the diagnosis of heparin-induced thrombocytopenia: A Bayesian approach. Int J Lab Hematol 2020; 43:468-476. [PMID: 33244896 DOI: 10.1111/ijlh.13404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The accurate diagnosis of heparin-induced thrombocytopenia (HIT) is essential to ensure adequate treatment and prevent complications. First step diagnosis test are immunoassays including enzyme-linked immunosorbent assays (ELISAs) and rapid immunoassays. METHODS Using a Bayesian approach, we prospectively evaluated the performance of the IgG PF4/polyvinylsulfonate ELISA and a chemiluminescent immunoassay (CLIA), which are specific for IgG and use the same antigenic target to detect HIT antibodies. RESULTS One hundred and eighty-four 184 consecutive patients with an intermediate (n = 159) or high (n = 25) clinical pretest probability of HIT based on the 4Ts score or platelet pattern were included. Both immunoassays (IAs) were performed on all 184 samples, and definite HIT was confirmed with a positive serotonin release assay in 29 patients (12.7%). The sensitivity (Ss) and negative predictive value (NPV) of ELISA were excellent (100%) allowing HIT to be excluded with good confidence when the test was negative. In addition, the Ss and NPV of the CLIA equalled 93.1% and 98.6%, respectively, as it was negative in two definite HIT. When the CLIA was negative, the post-test probability of HIT was 0.7% in case of intermediate risk. Although there was excellent agreement between CLIA and ELISA results, the quantitative values provided by the two IAs were not correlated. CONCLUSION AcuStar HIT® detects more than 90% of HIT, as do all rapid IAs, and appears to be a good tool for excluding HIT when the pretest probability is intermediate. A chemiluminescent signal higher than 10 IU/mL is highly predictive of definite HIT with a PPV of 100%.
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Affiliation(s)
- Emilie Jousselme
- Department of Haematology-Haemostasis, Civil Hospices of Lyon, Bron, France
| | - Eve-Anne Guéry
- Department of Haematology-Haemostasis, Regional University Hospital of Tours, Tours, France
| | - Christophe Nougier
- Department of Haematology-Haemostasis, Civil Hospices of Lyon, Bron, France
| | - Frédéric Sobas
- Department of Haematology-Haemostasis, Civil Hospices of Lyon, Bron, France
| | - Jérôme Rollin
- Department of Haematology-Haemostasis, Regional University Hospital of Tours, Tours, France.,EA 7501 GICC, University of Tours, Tours, France
| | - Yves Gruel
- Department of Haematology-Haemostasis, Regional University Hospital of Tours, Tours, France.,EA 7501 GICC, University of Tours, Tours, France
| | - Caroline Vayne
- Department of Haematology-Haemostasis, Regional University Hospital of Tours, Tours, France.,EA 7501 GICC, University of Tours, Tours, France
| | - Claire Pouplard
- Department of Haematology-Haemostasis, Regional University Hospital of Tours, Tours, France.,EA 7501 GICC, University of Tours, Tours, France
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Li S, Fan LK, Wu W, Zhao YQ, Wang SJ. [Diagnostic value of two immunoassays for detecting heparin/PF4 complex antibodies in heparin-induced thrombocytopenia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:411-416. [PMID: 31207707 PMCID: PMC7342243 DOI: 10.3760/cma.j.issn.0253-2727.2019.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Indexed: 11/05/2022]
Abstract
Objectives: To assess the diagnostic values of latex immunoturbidimetric assay (LIA) and particle immunofiltration assay (PIFA) for heparin-induced thrombocytopenia (HIT) . Methods: Samples from 94 patients with suspected HIT from May 2016 to July 2018 in our hospital were prospectively analyzed by the two immunoassays. Their medical records and further follow-up data were also collected and analyzed by our hematologists to make the 4Ts scores and confirm the diagnosis of HIT, respectively. Performance characteristics of the two immunoassays were assessed, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) . Their post-test probabilities (PTP) were also calculated based on the 4Ts score. Results: Among 94 cases, 15 (16.0%) had a positive HIT, including 6 of 37 (16.2%) with an intermediate, and 9 of 15 (60.0%) with a high 4Ts score. PIFA operating characteristics were: sensitivity 100.0% (15/15) , specificity 51.9% (41/80) , PPV 28.3% (15/53) , NPV 100.0% (41/41) . The positive PTP in intermediate and high 4Ts score group were 28.7% and 75.7%, respectively, while negative PTP were all 0. At manufacturers' cutoffs, LIA operating characteristics were: sensitivity 66.7% (10/15) , specificity 94.9% (75/79) , PPV 71.4% (10/14) and NPV 93.8% (75/80) . The positive and negative PTP in intermediate 4Ts score group were 71.8% and 6.3%, while 95.2% and 34.4% in high 4Ts score group, respectively. Receiver operating characteristic (ROC) analysis manifested that LIA was preferable than PIFA, and combining the 2 assays together was significantly better than single test. Conclusions: 4Ts score is still an important tool for the diagnosis of HIT. Combining clinical score with heparin/PF4 antibody assay can increase the accuracy of confirming or excluding HIT. Although PIFA is inferior to LIA in the diagnostic value, its user friendliness and 100% NPV have major advantages. Combining the 2 assays together can achieve a higher diagnostic value.
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Affiliation(s)
- S Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - L K Fan
- Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - W Wu
- Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - Y Q Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - S J Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recent findings on heparin-induced thrombocytopenia (HIT), a prothrombotic disorder caused by platelet-activating IgG targeting platelet factor 4 (PF4)/polyanion complexes. RECENT FINDINGS HIT can explain unusual clinical events, including adrenal hemorrhages, arterial/intracardiac thrombosis, skin necrosis, anaphylactoid reactions, and disseminated intravascular coagulation. Sometimes, HIT begins/worsens after stopping heparin ('delayed-onset' HIT). Various HIT-mimicking disorders are recognized (e.g., acute disseminated intravascular coagulation/'shock liver' with limb ischemia). HIT has features of both B-cell and T-cell immune responses; uptake of PF4/heparin complexes into macrophages ('macropinocytosis') facilitates the anti-PF4/heparin immune response. Antibody-induced activation of monocytes and platelets via their FcγIIA receptors triggers an intense procoagulant response. Sometimes, HIT antibodies recognize PF4 bound to (platelet-associated) chondroitin sulfate, explaining how HIT might occur without concurrent or recent heparin (delayed-onset HIT, 'spontaneous HIT syndrome'). The molecular structure of HIT antigen(s) has been characterized, providing a rationale for future drug design to avoid HIT and improve its treatment. The poor correlation between partial thromboplastin time and plasma argatroban levels (risking subtherapeutic anticoagulation) and need for intravenous administration of argatroban have led to increasing 'off-label' treatment with fondaparinux or one of the direct oral anticoagulants. SUMMARY Understanding the molecular mechanisms and unusual clinical features of HIT will improve its management.
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Platelet factor 4/heparin complexes present epitopes differently on solid-phase vs platelet surfaces. Blood 2017; 129:3498-3501. [DOI: 10.1182/blood-2017-02-769786] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zammar SG, Pockaj BA, Stucky CC, Wasif N, Gray RJ. Is forgoing chemical venous thromboembolism prophylaxis for women undergoing breast-conserving surgery for breast cancer safe? Am J Surg 2016; 212:1162-1166. [PMID: 27773376 DOI: 10.1016/j.amjsurg.2016.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cancer patients have a 4 to 7 fold increased risk of venous thromboembolism (VTE) vs the normal population. Chest guidelines recommend no chemical VTE prophylaxis for women with a <1.5% risk for VTE. Although the risk of VTE among women undergoing breast-conserving therapy is reported to be low overall, the rate without chemical prophylaxis has not been defined. The objective of the study was to establish the VTE risk among women undergoing breast-conserving surgery (BCS) who did not receive chemical VTE prophylaxis. METHODS From a prospective breast cancer database, 1,000 consecutive patients who underwent BCS without chemical VTE prophylaxis and with mechanical prophylaxis (support hose and intermittent pneumatic compression devices) were analyzed for VTE occurrence within 30 days postoperatively. Institutional review board approval was obtained. RESULTS The mean age was 65.4 ± 11.7 years, and mean body mass index was 27.3 ± 5.7. About 81.9% of the patients were postmenopausal. Median tumor size was 1.1 cm, and 24.7% of patients had lymph node metastases. The 30-day rate of clinically significant VTE was 0% (95% CI 0% to .37%). Hematomas requiring surgical intervention occurred among .6% of patients. CONCLUSIONS This cohort demonstrates that breast cancer patients undergoing BCS may be safely managed without chemical VTE prophylaxis because the risk with only mechanical prophylaxis is acceptable.
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Affiliation(s)
- Samer G Zammar
- Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Barbara A Pockaj
- Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Chee Chee Stucky
- Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Nabil Wasif
- Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Richard J Gray
- Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
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Demand on-demand testing for the diagnosis of heparin-induced thrombocytopenia. Thromb Res 2016; 140:163-164. [DOI: 10.1016/j.thromres.2016.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/13/2016] [Indexed: 12/31/2022]
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Sun L, Gimotty PA, Lakshmanan S, Cuker A. Diagnostic accuracy of rapid immunoassays for heparin-induced thrombocytopenia. A systematic review and meta-analysis. Thromb Haemost 2016; 115:1044-55. [PMID: 26763074 DOI: 10.1160/th15-06-0523] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/03/2015] [Indexed: 01/15/2023]
Abstract
The platelet factor 4/heparin ELISA has limited specificity for heparin-induced thrombocytopenia (HIT) and frequently does not provide same-day results. Rapid immunoassays (RIs) have been developed which provide results in 30 minutes or less. We conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of RIs for HIT. We searched the literature for studies in which samples from patients with suspected HIT were tested using a RI and a functional assay against which the performance of the RI could be measured. We performed sensitivity analyses of studies that directly compared different RIs with each other and with ELISAs. Estimates of sensitivity and specificity for each RI were calculated. Twenty-three articles, collectively involving six different RIs, met eligibility criteria. All RIs exhibited high sensitivity (0.96 to 1.00); there was wider variability in specificity (0.68 to 0.94). Specificity of the IgG-specific chemiluminescent assay (IgG-CA) was greater than the polyspecific chemiluminescent assay [0.94 (95 %CI 0.89-0.99) vs 0.82 (0.77-0.87)]. The particle gel immunoassay demonstrated greater specificity than the polyspecific ELISA [0.96 (0.95-0.97) vs 0.91 (0.89-0.92)]. The IgG-CA and lateral flow immunoassay [0.94 (0.91-0.97)] exhibited greater specificity than the IgG-specific ELISA [0.86 (0.82-0.90)]. Given their high sensitivity and rapid turnaround time, RIs are a reliable means of excluding HIT at the point-of-care in patients with low or intermediate clinical probability. Additionally, some RIs have greater specificity than HIT ELISAs. In summary, IgG-specific RIs appear to have improved diagnostic accuracy compared with ELISAs in patients with suspected HIT and may reduce misdiagnosis and overtreatment.
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Affiliation(s)
| | | | | | - Adam Cuker
- Adam Cuker, MD, MS, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA, Tel.: +1 215 615 6555, Fax: +1 215 615 6599, E-mail:
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