HIT Weekly Series Episode 6 - Conclusions

Today, HIT remains a critical clinical context in many hospital settings, when heparin, mainly unfractionated, is used in cardiology, intensive care units, or ECC, including CPB and increasingly ECMO. This is a paradoxal disease, as this anticoagulant drug can provoke thrombocytopenia associated with thrombosis in affected patients. Detecting the risk of HIT is mandatory, as it requires an immediate heparin withdrawal, and to switch to another anticoagulant therapy. However, if ruled out, heparin can be continued as it isthe anticoagulant of choice for some disorders, such as in cardiology or vascular disease patients. Until now, diagnosis of HIT mainly involves the clinical probability evaluation, testing for presence of heparin-dependent antibodies (IgG isotype) with an immunoassay, and confirmation with a functional assay (rarely available on site). This diagnosis remains inaccurate due to the low specificity of the immunological testing, many of the antibodies being asymptomatic. Use of a functional assay is mandatory for confirming HIT. Those available until now are complicate, and restricted  to few laboratories, or only used for academic applications. Results are then reported with a high delay, and not useful for the immediate management of affected patients.

The new Flow Cytometry functional assay introduced, Emosis HIT Confirm®, overwhelms these limitations, and allows using this functional assay, on demand, in any site equipped with a flow cytometer. Only a platelet rich plasma from a single healthy donor is required, without any need for a cumbersome donor selection, and multiple testing. Only reactivity verification with a positive control is needed. This assay is a one-step method, requiring only 10 pi of tested patient`s plasma; it is performed within 30 minutes with ready to use, liquid reagents. It is always available on- site and on-demand, gives clear and easy-repeatable results, which are not operator-dependent. This introduces new possibilities, and a unique tool for a rapid confirmation of HIT, thus allowing to implement the most appropriate patient management in each clinical context.