对疑似肝素诱导的血小板减少症(HIT)患者进行快速准确的诊断对于患者管理至关重要,但仍然具有挑战性。当前的HIT诊断理想地依赖于临床信息的组合,免疫测定和功能测定结果。血小板活化测定或功能测定检测临床上更显著的HIT抗体。在文献中已经开发和评估了几种功能测定。它们在研究的活化终点不同;使用的技术或技术;血小板供体选择;血小板悬浮液(洗涤的血小板,富含血小板的血浆或全血);患者样本(血清或血浆);以及使用的肝素(类型和浓度)。执行的控制和相关结果解释中的不一致是常见的。阈值和性能在论文中的确定方式不同。功能测定遭受实验室间变异性。这种标准化的缺乏限制了实验室中功能测定的评估和可及性。在本文中,我们回顾了所有当前的激活端点,为HIT诊断开发的功能测定技术和方法。
A rapid and accurate diagnosis in patients with suspected heparin-induced thrombocytopenia (HIT) is essential for patient management but remains challenging. Current HIT diagnosis ideally relies on a combination of clinical information, immunoassay and functional assay results. Platelet activation assays or functional assays detect HIT antibodies that are more clinically significant. Several functional assays have been developed and evaluated in the literature. They differ in the activation endpoint studied; the technique or technology used; the platelet donor selection; the platelet suspension (washed platelets, platelet rich plasma or whole blood); the patient sample (serum or plasma); and the heparin used (type and concentrations). Inconsistencies in controls performed and associated results interpretation are common. Thresholds and performances are determined differently among papers. Functional assays suffer from interlaboratory variability. This lack of standardization limits the evaluation and the accessibility of functional assays in laboratories. In the present article, we
review all the current activation endpoints, techniques and methodologies of functional assays developed for HIT diagnosis.