Protocol and apparatus for determining heparin-induced thrombocytopenia
A hemostasis analyzer, such as the Thrombelastograph® (TEG®) hemostasis analyzer is utilized to measure continuously in real time, the hemostasis process from the initial fibrin formation, through platelet-fibrin interaction and lysis to generate blood hemostasis parameters. The measured blood hemostasis parameters permit determination of heparin-induced thrombocytopenia II complex (HiT II).
1. An apparatus for determining heparin-induced thrombocytopenia complex (HiT) comprising:
a first hemostasis testing cell to test a first portion of a whole blood sample taken from a HiT suspect patient to determine a first blood sample characteristic including at least one of clot strength, clot elasticity, clot rate of formation and a clot rate of lysis of the first portion and to provide first blood sample characteristic data indicative of the same;
a second hemostasis testing cell to test a second portion of the whole blood sample to determine a second blood sample characteristic including at least one of clot strength, clot elasticity, clot rate of formation and a clot rate of lysis of the second portion and to provide second blood sample characteristic data indicative of the same, the second portion having heparin added in vitro in a quantity sufficient to overwhelm platelet activation within the second portion; and
a processor coupled to the first testing cell and the second testing cell to receive the first blood sample characteristic data and the second blood sample characteristic data, respectively, the processing being programmed to provide an indication of the presence of HiT based upon the first blood sample characteristic data and the second blood sample characteristic data.
2. The apparatus of claim 1 , the quantity comprises a quantity of heparin in excess of or equal to 5 microliters (ul) of 1 Units/milliliter (U/ml).
3. The apparatus of claim 1 , the quantity comprises a quantity of heparin in excess of or equal to 5 microliters (ul) of 3 Units/milliliter (U/ml).
4. The apparatus of claim 1 , the quantity comprises a quantity of heparin in excess of or equal to 5 microliters (ul) of 30 Units/milliliter (U/ml).
5. The apparatus of claim 1 , the quantity comprises a quantity of heparin in the range of 5 microliters (ul) of 1 Units/milliliter (U/ml) to 5 microliters (ul) of 30 Units/milliliter (U/ml).
6. The apparatus of claim 1 , wherein the second blood sample characteristic represents a fibrin contribution to hemostasis.
7. The apparatus of claim 1 , wherein the first blood sample characteristic represents a contribution to hemostasis of activated platelets in the presence of HiT.
8. The apparatus of claim 1 , comprising a third hemostasis testing cell to test a third portion of the whole blood sample to determine a third blood sample characteristic including at least one of clot strength, clot elasticity, clot rate of formation and a clot rate of lysis of the third portion and to provide third blood sample characteristic data indicative of the same, the third portion having heparin added in vitro in another quantity, different than the quantity sufficient to overwhelm platelet activation within the second portion; and
the processor being coupled to the third testing cell to receive the third blood sample characteristic data and the processor being programmed to provide an indication of the presence of HiT based upon the first blood sample characteristic data, the second blood sample characteristic data and the third blood sample characteristic data.
9. The apparatus of claim 1 , wherein each of the first portion and the second portion comprises a platelet rich plasma (PRP)-patient plasma mixture.
10. The apparatus of claim 1 , wherein each of the first portion and the second portion comprises patient whole blood.
11. The apparatus of claim 1 , wherein each of the first portion and the second portion comprises an activator.
12. The apparatus of claim 1 , wherein the first testing cell and the second testing cell each are testing cells of a multi-testing cell hemostasis testing machine.
13. The apparatus of claim 1 , wherein the first testing cell comprises a testing cell of a first hemostasis testing machine and the second testing cell comprises a testing cell of a second hemostasis testing machine.
14. The apparatus of claim 11 , wherein the activator comprises a compound effective to promote clot formation.
15. The apparatus of claim 11 , wherein the activator comprises a compound effective to produce fibrin.
16. The apparatus of claim 11 , wherein the activator comprises a compound effective to stabilize cross-linked fibrin.
17. The apparatus of claim 11 , wherein the activator comprises a compound including Retilase and Factor XIIIa.
18. The apparatus of claim 1 , wherein the first blood sample characteristic a first blood sample clot strength and the second blood sample characteristic comprises a second blood sample clot strength, and the processor is programmed to provide a comparison of the first blood sample clot strength and the second blood sample clot strength.
19. The apparatus of claim 18 , wherein the processor is programmed to provide a comparison of at least two times the first blood sample clot strength relative to the second blood sample clot strength.
20. The apparatus of claim 8 , wherein the first blood sample characteristic a first blood sample clot strength, the second blood sample characteristic comprises a second blood sample clot strength and the third blood sample characteristic comprises a third blood sample clot strength, and the processor is programmed to provide a comparison of the first blood sample clot strength, the second blood sample clot strength and the third blood sample.
21. The apparatus of claim 20 , wherein the processor is programmed to provide a comparison of at least two times the first blood sample clot strength or the third blood sample clot strength relative to the second blood sample clot strength.