Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Heparin-induced thrombocytopenia during renal replacement therapy in the intensive care unit. | Available online http content 12 3 158 Commentary Heparin-induced thrombocytopenia during renal replacement therapy in the intensive care unit Andrew Davenport Royal Free and University College Medical School UCL Centre for Nephrology Hampstead Campus Rowland Hill Street London NW3 2PF UK Corresponding author Andrew Davenport Published 30 June 2008 This article is online at http content 12 3 158 2008 BioMed Central Ltd Critical Care 2008 12 158 doi cc6914 See related research by Lasocki et al. http content 12 3 R84 Abstract Whereas some 30 to 50 of patients admitted to the intensive care unit develop thrombocytopenia during their stay the incidence of heparin-induced thrombocytopenia HIT remains low at around to . Lasocki and colleagues prospectively tested patients with premature clotting of the hemofiltration circuit for HIT and reported a 25 incidence of HIT particularly if the circuit clotted within 6 hours. By switching the anticoagulant from heparin to danaparoid the hemofiltration circuit survival and urea clearances improved. HIT should therefore be clinically suspected if extracorporeal circuits clot repeatedly. The diagnosis of heparin-induced thrombocytopenia HIT depends upon clinical suspicion and laboratory testing. Unfortunately only a limited number of laboratories in the world are now capable of performing the gold-standard platelet serotonin release assay to determine whether the antibodies are pathogenic. Most laboratories as with Lasocki and colleagues 1 therefore rely on commercially available enzyme immunoassays EIAs - which have a high sensitivity due to a high negative predictive value but have variable specificity as they also detect IgA and IgM antibodies which are probably not pathogenic 2 . Functional assays of platelet aggregation are therefore often used to confirm EIA results. Heparin binds to surface-bound platelet factor 4 PF4 and although used as .
