HEPARIN-INDUCED THROMBOCYTOPENIA - A SURVEY OF TESTS EMPLOYED AND ATTITUDES IN HEMATOLOGY LABORATORIES

A survey was carried out of the attitudes adopted in French laboratories with regard to the diagnosis of heparin-induced thrombocytopenia (HIT). The platelet aggregation assay is used in 100% of laboratories, aggregation being measured by light transmission in an aggregometer (3/4). Blood is drawn either in emergency (1/4) or after heparin discontinuation (1/4). The nature of the samples for testing is a fresh citrated plasma (100%) although frozen plasma is occasionally employed, while 40% of laboratories use less than 3 control platelet donors. Platelet response is verified in the presence of a non immune agonist (18%) or an immune challenge (known positive plasma or platelet activating monoclonal antibody) (13%). Heparin is of the same type as received by the patient and is tested at two or more concentrations of approximately 0.5 and 1.0 IU/ml, but rarely at high concentration (100 IU/ml). The platelet count is adjusted to 250 - 350 x 10(9)/l (18%), the ratio of patient plasma to PRP is 1:1 (59%), the time of observation is about 20 min (50%) and control platelets are tested with heparin to rule out any false positive results (9/10). Standardization is nevertheless required if the platelet aggregation assay is to be considered as a reference test.