Spontaneous heparin-induced thrombocytopenia syndrome: 2 new cases and a proposal for defining this disorder.

Abstract:

:The existence of spontaneous heparin-induced thrombocytopenia (HIT) syndrome (or autoimmune HIT), defined as a transient prothrombotic thrombocytopenic disorder without proximate heparin exposure serologically indistinguishable from HIT, is controversial. We describe 2 new cases presenting with thrombotic stroke/thrombocytopenia: one following shoulder hemi-arthroplasty (performed without heparin) and the other presenting to the emergency room without prior hospitalization, heparin exposure, or preceding infection. Both patients tested strongly positive for anti-platelet factor 4 (PF4)/heparin immunoglobulin (Ig)G in 2 different immunoassays and in the platelet serotonin-release assay. Crucially, both patients' sera also caused strong (>80%) serotonin release in the absence of heparin, a serologic feature characteristic of delayed-onset HIT (ie, where heparin use precedes HIT but is not required for subsequent development or worsening of thrombocytopenia). We propose that a rigorous definition of spontaneous HIT syndrome should include otherwise unexplained thrombocytopenia/thrombosis without proximate heparin exposure and with anti-PF4/heparin IgG antibodies that cause strong in vitro platelet activation even in the absence of heparin.

journal_name

Blood

journal_title

Blood

authors

Warkentin TE,Basciano PA,Knopman J,Bernstein RA

doi

10.1182/blood-2014-01-549741

subject

Has Abstract

pub_date

2014-06-05 00:00:00

pages

3651-4

issue

23

eissn

0006-4971

issn

1528-0020

pii

blood-2014-01-549741

journal_volume

123

pub_type

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