Heparin-induced thrombocytopenia (HIT) is a disorder characterized by antibody-mediated
platelet activation and vascular thrombosis in patients exposed to heparin. Traditionally,
the diagnosis is supported by platelet-factor 4 (PF4)/heparin enzyme-immunoassay (EIA)
and confirmed with a functional assay, like the serotonin release assay (SRA). We
describe a patient with a clinical course highly suspicious for HIT despite an initially
weakly positive, then negative, PF4 antibody and repeatedly negative SRA. This should
alert clinicians to the growing evidence of double-negative (PF4 negative/SRA negative)
HIT as a clinical entity.
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References
- Serotonin-release assay-negative heparin-induced thrombocytopenia.Am J Hematol. 2020; 95: 38-47https://doi.org/10.1002/ajh.25660
- A novel PF4-dependent platelet activation assay identifies patients likely to have heparin-induced thrombocytopenia/thrombosis.Chest. 2016; 150: 506-515https://doi.org/10.1016/j.chest.2016.02.641
- PF4/polyanion ELISA-negative antibodies to PF4 and non-PF4 targets can mediate platelet activation and cause heparin-induced thrombocytopenia (HIT).Res Pract Thromb Haemost. 2021; 5
Article info
Publication history
Published online: October 14, 2022
Footnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
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