False-Negative Platelet Factor 4 Antibodies and Serotonin Release Assay and the Utility of Repeat Testing in the Diagnosis of Heparin-Induced Thrombocytopenia and Thrombosis.

False-Negative Platelet Factor 4 Antibodies and Serotonin Release Assay and the Utility of Repeat Testing in the Diagnosis of Heparin-Induced Thrombocytopenia and Thrombosis. post thumbnail image
To report a case of false-negative serological checks within the prognosis of heparin-induced thrombocytopenia (HIT) adopted by a short evaluation of the literature on this matter.A 75-year-old Caucasian feminine affected person was admitted with a traumatic proper ankle fracture that required open discount and inside fixation.
Regardless of postoperative subcutaneous heparin chemoprophylaxis, she developed deep vein thrombosis (DVT) and pulmonary embolism (PE) on day four and subsequently began on steady heparin infusion. On day 5, she suffered a stroke from a whole occlusion of the appropriate widespread carotid artery with tandem occlusion of the appropriate center cerebral artery.
She underwent profitable thrombectomy of each arteries. The proposed stroke mechanism was paradoxical embolism by a patent foramen ovale. Over the subsequent few days, thrombocytopenia was famous, the heparin drip was stopped, and HIT antibodies (antibodies focusing on the complicated of platelet issue four and heparin; PF4-H AB) and serotonin launch assay (SRA) checks had been despatched.
Due to the suspicion for HIT, she was began on bivalirudin with subsequent enchancment in platelet rely. Preliminary PF4-H AB and SRA checks had been unfavorable, bivalirudin was stopped, and heparin was restarted. Subsequently, her platelets trended down, once more elevating scientific suspicion of HIT. Repeat PF4-H AB and SRA testing resulted constructive.
A constructive SRA within the acceptable context is taken into account for the prognosis of heparin-induced thrombocytopenia. This case report highlights that false-negative serological analysis is feasible early in the midst of the illness. Repeat testing is advisable in sufferers with excessive scientific suspicion.

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