A colleague sent this additional material on the subject of a rapid HIT test posted by Julia Witt: I wanted to send you the attached six-slide PowerPoint on heparin-induced thrombocytopenia (HIT) testing using whole blood aggregometry. The assay (and the PowerPoint) was developed at CHUS- Fleurimont Hospital in Sherbrooke, Quebec by Dr. Mariette Lepine. Whole blood aggregometry offers the advantage of no blood specimen preparation.
Click here to download the PowerPoint: HIT WBA.ppt
In follow-up to Julia Witt’s July 9 post requesting information on the PIFA AB rapid test for heparin-induced thrombocytopenia, attached below is an article that defines and illustrates the 4T protocol: Lo GK, Juhl D, Warkentin TE, Igouin S, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T’s) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemostas 2006, 4: 759–65. Special thanks to Joyce Low for referencing 4 T. Click here for the article: 4ts
From Julia Witt: Our healthcare system is currently looking at more efficient ways to screen for heparin-induced thrombocytopenia with thrombosis (HIT). Currently we are looking at the Akers Biosciences PIFA AB test. The literature looks good, but I wonder how many are using this test and can it be reliably used as a rule out test for HIT? Our current workflow is to place our patients on direct thrombin inhibitors (DTIs) until we have a confirmation by the serotonin release assay (SRA). This is time-consuming and costly. So a faster TAT with an ability to reliably rule out is very necessary. What are others doing and if using PIFA AB testing, what are their thoughts and yours as well?
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George participates in CLSC5124E-Sp14; Advanced Hemostasis, a graduate course offered by Drs. Nadine Fydryszewski and Elaine Keohane of Rutgers University School of Biomedical and Health Sciences. The faculty also include Dr. Larry Smith and Prof. Donna Castellone. This course attracts experienced medical laboratory scientists from around the world who raise interesting questions, including this one about transient gestations protein S deficiency:
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Another message from colleague and friend Kelly Townsend, Tricore Reference Laboratories, Albuquerque. Hi George, at one of our large teaching hospitals, we are working with the Internal Medicine department to establish “best practices” for ordering thrombophilia testing on inpatients. Has anyone out there successfully implemented guidelines they are willing to share? Any recent references would also be greatly appreciated. Thanks!
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From Molly Klima, University Hospitals of Cleveland: Hi George, we are in the process of bringing up the Instrumentation Laboratory Silica Clotting Time (SCT) assay and are struggling with the CPT code. Since there is no straightforward CPT for the assay our dilemma is as follows:
- 85730 Thromboplastin time, partial (PTT); plasma or whole blood
- 85732 Thromboplastin time, partial (PTT); plasma or whole blood substitution, plasma fractions, each
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Thanks to colleague Ali Sadeghi-Khomami PhD for his heads-up announcing the International Society on Thrombosis and Haemostasis‘ World Thrombosis Day launch. World Thrombosis Day will be held annually on October 13, the birthday of Rudolph Virchow, 1821, who coined the terms embolism and thrombosis. See the ISTH World Thrombosis Day page for details.
Charlie Muller, Helen Hayes Hospital TW, posted a question on the Medlab list, paraphrased here with his permission. He is validating the Akers PIFA Heparin/PF4 rapid assay kit for heparin induced thrombocytopenia with thrombosis, and needs a good way to validate it in addition to using Akers’ panels. Charlie’s setting is an acute rehab specialty hospital where a very large majority of patients have been exposed to heparin in various surgical procedures. They consult with a pathologist from Columbia University Medical Center who has had several discussions with the medical staff about HIT being a clinical diagnosis, using Warkentin’s 4T, etc. The staff want a little extra guidance from a rapid lab test.