From Jeanine Walenga, PhD, Loyola University Medical Center, Maywood, IL: When we perform the test for heparin-induced thrombocytopenia with thrombosis (HIT) using platelet aggregation, we use a reagent to remove heparin contaminant from the patient sample–ecteola cellulose. If there is a positive baseline (spontaneous aggregation with no heparin reagent added) we assume that there may be heparin in the patient sample. Se we treat the sample with ecteola cellulose, centrifuge, then retest the sample in the HIT aggregation assay. We just learned that the company Inotech Biosystems International, Inc. will not supply the ecteola cellulose until they find another manufacturer. Is there another source, preferably a clinical kit (not Sigma)? If Sigma is the only source, does someone have a clinical protocol? Thanks.
Here is a recent note from Lauren Smith Helfgott, applications specialist at Chrono-log Corporation:
“Hello, George. A clinician and I were recently discussing platelet aspirin-like defect (secretion disorder). He came across slides 28 and 30 from the Fritsma Factor audio module Platelet Function Testing Part 2 and sent them over. The tracings are labeled ‘aspirin or aspirin-like (secretion) disorder,’ and are attributed to Edward Masel, University of Rochester Medical Center, Rochester NY, dated 3/22/06. According to our communications with Ed, these tracings are actually from a patient with an acquired secretion defect due to platelet antibodies. We just wanted you to be aware that this patient had a platelet secretion defect as a result of antibodies; not an inherited secretion disorder.”
Read more »
From Tereza Munhoz, PUCRS:
Hi, George, What your experience with HIT test? We intend to use the IL test. What do you know about it? Thanks for your attention.
Read more »
Another interesting discussion from our UMDNJ graduate Hemostasis course:
(Original post February 1, 2012, re-posted January 15, 2013 to encourage comments)
About 6 years back, I caught wind of a discussion regarding platelet substitutes, which I found quite intriguing. I did some digging as a result of this discussion and am amazed by the potential of such technologies. It appears that platelet rich plasma (PRP) gel has been around for some time, more than two decades according to Carter, et al. (2011). Do you know how often and in what circumstances such a technology as PRP gel is utilized?
Read more »
I am reconstructing previous Fritsma Factor posts subsequent to the crashes we experienced in November and December and came across an April 12, 2012 communication from an individual who has non-symptomatic thrombocytopenia with giant platelets. I suggested this could be one of the MYH9 mutations such as May-Hegglin anomaly. I post this link now, hoping to attract comments from some platelet experts. Please respond if you have more information on this interesting case.
Attached to the December 28 post, “Platelet Function Testing and the Bleeding Time” with the AC Ivy story was the question, “Is the Accumetrics VerifyNow aggregometer useful for screening patients for inherited platelet function disorders?” Yes, I consider the VerifyNow assay effective in screening for platelet function defects, like storage pool disorder or platelet secretion disorder (aspirin-like syndrome), however I find no reference to this function on the Accumetrics web site, which highlights only their FDA-cleared assays for aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitor efficacy. Consequently, I have placed an inquiry with the company’s technical service department and will post their answer when it arrives.
Read more »
From Lynn Gingras, MT (ASCP), Rush-Copley Medical Center: Our institution is getting several complaints from the cardiologists as to the turnaround time of the heparin-induced platelet antibody (HIPA, heparin-induced thrombocytopenia with thrombosis, HIT, HITT) testing that we currently send out to a reference lab. Is there any value to bringing in the Akers Bioscience Particle ImmunoFiltration Assay (PIFA) heparin/PF4 rapid assay system as a quick qualitative answer for them? I do not know of any labs in my area using that technology. Please provide your input and/or suggestions.
Read more »
In 2009 Dave McGlasson and I published McGlasson DL, Fritsma GA, Whole blood platelet aggregometry and platelet function testing. Semin Thromb Hemost 2009;35:168–80. This article, the second-most cited in the 2009 Seminars in Thrombosis and Hemostasis, reminded me of our Quick Question about the Ivy bleeding time posted in early November, and subsequently lost when our site crashed in late November. While my goal in posting the Quick Question was to reemphasize the futility of the bleeding time, my research led me to a lengthy and engrossing article by medical historian Dr. Patricia Spain Ward, 1931–1995, “Who Will Bell the Cat? Andrew C. Ivy and Krebiozen.” The article was developed from a speech given by Dr. Ward at the Morris Fishbein Center for the Study of the History of Science and Medicine, University of Chicago on April 8, 1983 and published in the Bulletin of the History of Medicine 1984;58:28–52. I’ve prepared a brief summary of the bleeding time test, attached, Ivy’s role in its development, and his subsequent fall from grace when he promoted a false cancer cure. The “Bell the Cat” phrase refers to Aesop’s fable in which a group of mice held a meeting to decide how to prevent the cat from sneaking up on them. One mouse suggests they tie a bell to the cat, and all the others rejoice at the solution until a wise elder rose to ask, “Who will bell the cat?” No one was able to tie the bell to Ivy. To read, please click on AC Ivy Story.