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Anesth Analg 2008; 107:379-381
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e318172af0f
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CARDIOVASCULAR ANESTHESIOLOGY

Urgent Cardiac Surgery in a Patient with a Remote History of Heparin-Induced Thrombocytopenia: Use of the Anti-PF4/Heparin ELISA Confirmatory Test

Suzanne M. Dellaria, MD*, Philip E. Greilich, MD*, and Ravindra Sarode, MD{dagger}

From the Departments of *Anesthesiology and Pain Management, {dagger}Pathology, UT Southwestern Medical Center, Dallas, Texas.

Address correspondence and reprint requests to Suzanne Dellaria, MD, 5323 Harry Hines Blvd./Dallas, TX 75390-9202. Address e-mail to suzanne.dellaria{at}utsouthwestern.edu.

Abstract

The use of established heparin protocols when heparin-induced thrombocytopenia (HIT) antibodies are negative is currently recommended for the management of patients with previous HIT who require cardiac surgery. Routine preoperative testing for HIT antibodies using an anti-PF4/heparin enzyme-linked immunosorbent assay (ELISA) introduces the problem of detecting nonpathogenic HIT antibodies, which can lead to a false diagnosis of the presence of platelet-activating antibodies. Our case report demonstrates the clinical utility of a newer confirmatory procedure performed using high dose heparin. We use this procedure in situations in which pretest probability is low (remote HIT) and the anti-PF4/heparin ELISA test results are weak to moderately positive (absorbance 0.4-1.0).




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A. Greinacher and J. H. Levy
HIT Happens: Diagnosing and Evaluating the Patient with Heparin-Induced Thrombocytopenia
Anesth. Analg., August 1, 2008; 107(2): 356 - 358.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.