Harenberg J, Huhle G, Giese C, Wang L C, Feuring M, Song X H, Hoffmann U
1st Department of Medicine, University Hospital, Faculty of Clinical Medicine Mannheim of the Ruprecht-Karls University of Heidelberg, Germany.
Br J Haematol. 2000 Apr;109(1):182-6. doi: 10.1046/j.1365-2141.2000.01966.x.
[14C]-Serotonin release assay (14C-SRA) from platelets is considered to be the most sensitive test for laboratory confirmation of heparin-induced thrombocytopenia (HIT). This study compared 14C-SRA with an enzyme immunoassay (EIA) to determine the release of serotonin from platelets in the presence of heparin and serum from HIT patients. The normal range (median, 2.5 and 97.5 percentiles) of serotonin release from platelets in healthy subjects (n = 149) is 38 ng/ml (19 and 62) measured by EIA-SRA. Serum from HIT patients (n = 42) released 2548 ng/ml (244 and 7987) serotonin in the presence of 0.1 IU/ml heparin and 29 ng/ml (13 and 76) in the presence of 100 IU/ml heparin. One hundred per cent and 15% of HIT samples exhibited an elevated serotonin release from platelets in the presence of 0.1 IU/ml low molecular weight (LMW) heparin, 2100 ng/ml (869 and 5968), or danaparoid, 272 ng/ml (143 and 403), respectively. The sensitivity and specificity of the EIA-SRA was 100% and 97.4% and of the 14C-SRA 100% and 92.9% in HIT patients. No false-positive results were found in patients receiving heparin (n = 28), in patients with elevated levels of bilirubin (n = 5), in patients with antiphospholipid antibody syndrome (n = 10) or in non-HIT patients (n = 78) with both assays. The EIA technique to quantify serotonin release from platelets provides a reliable non-radioactive method to diagnose heparin-induced thrombocytopenia and to assess in vitro crossreactivity of low molecular weight heparins and heparinoid.
血小板[14C] - 5 -羟色胺释放试验（14C - SRA）被认为是实验室确诊肝素诱导的血小板减少症（HIT）最敏感的检测方法。本研究比较了14C - SRA与酶免疫测定法（EIA），以确定在肝素和HIT患者血清存在的情况下血小板中5 -羟色胺的释放情况。通过EIA - SRA测定，健康受试者（n = 149）血小板中5 -羟色胺释放的正常范围（中位数、第2.5和第97.5百分位数）为38 ng/ml（19和62）。在0.1 IU/ml肝素存在的情况下，HIT患者（n = 42）的血清释放2548 ng/ml（244和7987）的5 -羟色胺，在100 IU/ml肝素存在的情况下释放29 ng/ml（13和76）。在0.1 IU/ml低分子量（LMW）肝素（2100 ng/ml，869和5968）或达那肝素（272 ng/ml，143和403）存在的情况下，分别有100%和15%的HIT样本显示血小板5 -羟色胺释放升高。在HIT患者中，EIA - SRA的敏感性和特异性分别为100%和97.4%，14C - SRA的敏感性和特异性分别为100%和92.9%。在接受肝素治疗的患者（n = 28）、胆红素水平升高的患者（n = 5）、抗磷脂抗体综合征患者（n = 10）或非HIT患者（n = 78）中，两种检测方法均未发现假阳性结果。用于定量血小板中5 -羟色胺释放的EIA技术提供了一种可靠的非放射性方法来诊断肝素诱导的血小板减少症，并评估低分子量肝素和类肝素的体外交叉反应性。
