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Evaluation of 4T score for possible heparin induced thrombocytopenia diagnosis
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M. Shahbazi   , M. Ahmadinejad , A. Chegini |
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| Keywords: Key words: Thrombocytopenia, Heparin, Cardiac Surgery, Diagnosis |
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Full-Text [PDF 613 kb]
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| Abstract (HTML) (4637 Views)
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Type of Study: Research |
Subject:
Blood transfusion medicine
Published: 2017/12/30
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Full-Text: (3548 Views) |
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Sci J Iran Blood Transfus Organ 2018; 14(4): 272-280
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Evaluation of diagnostic value of 4T score for heparin induced thrombocytopenia
Shahbazi M.1, Ahmadinejad M.1, Chegini A.1
1Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
Abstract
Background and Objectives
Heparin induced thrombocytopenia (HIT) is a prothrombotic disorder. The antibody against PF4-heparin complex may lead to platelet activation, thrombotic events and death. We decided to evaluate diagnostic value of 4T score as a clinical diagnostic system among cardiac surgery patients for diagnosis of HIT.
Materials and Methods
In this descriptive study, 92 patients that underwent cardiac surgery from September 2015 till September 2016 in Tehran Modarres Hospital have been included. We evaluated 4Tscore criteria (4T stands for Thrombocytopenia, Time of thrombocytopenia, Thrombotic events and Other reasons for Thrombocytopenia) in all cases. Blood samples were obtained from patients with 4Tscore ≥ 4. Anti-platelet factor 4/heparin antibody (enzyme-immune assay, ELISA) was done for patients with 4Tscore ≥ 4 and the OD ≥ 0.2 was considered as positive and ≥1 as strong positive. Patients with 4Tscore ≥ 4 and strong positivity of ELISA test were considered as HIT.
Results
From 92 patients, 67 (72.8%) were male and 25 (27.2%) female. Mean age was 58±10.68 with 14 patients (15.2%) having 4Tscore ≥ 4. ELISA was positive (OD > 0.2) in 8 cases in 3 of whom ELISA being strongly positive (OD > 1). According to HIT definition in this study, the prevalence of HIT was 3.2%.
Conclusions
4T score should be evaluated for preliminary diagnosis of HIT in suspected patients treated with heparin but the use of this system alone without laboratory confirmation can lead to over diagnosis of HIT and inappropriate termination of heparin treatment.
Key words: Thrombocytopenia, Heparin, Cardiac Surgery, Diagnosis
Received: 5 Oct 2016
Accepted: 12 Sep 2017
Correspondence: Ahmadinejad M., MD. Assistant Professor of Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine.
P.O.Box: 14665-1157, Tehran, Iran. Tel: (+9821) 86704715; Fax: (+9821) 88622533
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