Falsely positive heparin‐induced thrombocytopenia antibody testing in severe hyperbilirubinemia

Abstract Heparin‐induced thrombocytopenia (HIT) is a life‐threatening pathologic reaction to heparin‐based products. Diagnosis of this condition can be confounded by other comorbidities or by acute illness—oftentimes presenting challenging clinical dilemmas, particularly in critically ill patients....

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Autores principales:	Daniel Egert, Vinicius Jorge, Adam Cuker, Gabor Varadi
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/39e670eb5306423882d228aee831044d
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spelling	oai:doaj.org-article:39e670eb5306423882d228aee831044d2021-11-29T09:35:29ZFalsely positive heparin‐induced thrombocytopenia antibody testing in severe hyperbilirubinemia2475-037910.1002/rth2.12608https://doaj.org/article/39e670eb5306423882d228aee831044d2021-10-01T00:00:00Zhttps://doi.org/10.1002/rth2.12608https://doaj.org/toc/2475-0379Abstract Heparin‐induced thrombocytopenia (HIT) is a life‐threatening pathologic reaction to heparin‐based products. Diagnosis of this condition can be confounded by other comorbidities or by acute illness—oftentimes presenting challenging clinical dilemmas, particularly in critically ill patients. A 67‐year‐old woman was admitted with liver failure and severe hyperbilirubinemia. She developed thrombocytopenia after prophylactic heparin exposure. Subsequent quantitative latex immunoturbidimetric assay (LIA) HIT antibody testing was intermediately positive. Confirmatory serotonin release assay testing subsequently returned negative. Platelet factor4–dependent P‐selectin expression assay also returned negative, suggesting false positivity of the initial LIA tests. Concern was raised that hyperbilirubinemia (total bilirubin, 55.5 mg/dL) interfered with the original assay. Further testing with a separate HIT ELISA assay, which includes multiple washes and dilutions of the serum in order to effectively remove bilirubin, returned negative. Medical providers must consider the possibility of false‐positive LIA testing when evaluating for HIT in the setting of severe hyperbilirubinemia.Daniel EgertVinicius JorgeAdam CukerGabor VaradiWileyarticleDiseases of the blood and blood-forming organsRC633-647.5ENResearch and Practice in Thrombosis and Haemostasis, Vol 5, Iss 7, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	Diseases of the blood and blood-forming organs RC633-647.5 Daniel Egert Vinicius Jorge Adam Cuker Gabor Varadi Falsely positive heparin‐induced thrombocytopenia antibody testing in severe hyperbilirubinemia
description	Abstract Heparin‐induced thrombocytopenia (HIT) is a life‐threatening pathologic reaction to heparin‐based products. Diagnosis of this condition can be confounded by other comorbidities or by acute illness—oftentimes presenting challenging clinical dilemmas, particularly in critically ill patients. A 67‐year‐old woman was admitted with liver failure and severe hyperbilirubinemia. She developed thrombocytopenia after prophylactic heparin exposure. Subsequent quantitative latex immunoturbidimetric assay (LIA) HIT antibody testing was intermediately positive. Confirmatory serotonin release assay testing subsequently returned negative. Platelet factor4–dependent P‐selectin expression assay also returned negative, suggesting false positivity of the initial LIA tests. Concern was raised that hyperbilirubinemia (total bilirubin, 55.5 mg/dL) interfered with the original assay. Further testing with a separate HIT ELISA assay, which includes multiple washes and dilutions of the serum in order to effectively remove bilirubin, returned negative. Medical providers must consider the possibility of false‐positive LIA testing when evaluating for HIT in the setting of severe hyperbilirubinemia.
format	article
author	Daniel Egert Vinicius Jorge Adam Cuker Gabor Varadi
author_facet	Daniel Egert Vinicius Jorge Adam Cuker Gabor Varadi
author_sort	Daniel Egert
title	Falsely positive heparin‐induced thrombocytopenia antibody testing in severe hyperbilirubinemia
title_short	Falsely positive heparin‐induced thrombocytopenia antibody testing in severe hyperbilirubinemia
title_full	Falsely positive heparin‐induced thrombocytopenia antibody testing in severe hyperbilirubinemia
title_fullStr	Falsely positive heparin‐induced thrombocytopenia antibody testing in severe hyperbilirubinemia
title_full_unstemmed	Falsely positive heparin‐induced thrombocytopenia antibody testing in severe hyperbilirubinemia
title_sort	falsely positive heparin‐induced thrombocytopenia antibody testing in severe hyperbilirubinemia
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/39e670eb5306423882d228aee831044d
work_keys_str_mv	AT danielegert falselypositiveheparininducedthrombocytopeniaantibodytestinginseverehyperbilirubinemia AT viniciusjorge falselypositiveheparininducedthrombocytopeniaantibodytestinginseverehyperbilirubinemia AT adamcuker falselypositiveheparininducedthrombocytopeniaantibodytestinginseverehyperbilirubinemia AT gaborvaradi falselypositiveheparininducedthrombocytopeniaantibodytestinginseverehyperbilirubinemia
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Falsely positive heparin‐induced thrombocytopenia antibody testing in severe hyperbilirubinemia

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