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From the Departments of *Anesthesiology and Pain Management,
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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