命中诊断：癌症患者肝素诱导的血小板减少症检测。
HITTING the Diagnosis: Testing for Heparin-Induced Thrombocytopenia in Cancer Patients.
机构信息
Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
出版信息
Am J Clin Pathol. 2018 Jul 3;150(2):116-120. doi: 10.1093/ajcp/aqy040.
OBJECTIVES
To evaluate the use of a pretest probability score (4Ts score) in cancer patients to guide ordering of laboratory screening tests for heparin-induced thrombocytopenia (HIT).
METHODS
A retrospective chart review was conducted for patients (n = 140) in whom laboratory testing for HIT was requested. 4Ts scores were calculated and correlated with heparin-endogenous platelet factor 4 antibody enzyme-linked immunosorbent assay (ELISA) test results.
RESULTS
All patients with a high pretest probability of HIT (4Ts score = 6-7) had positive ELISA results, compared to 26.1% of patients with intermediate (4Ts score = 4-5) and 4.3% of patients with low (4Ts score ≤3) pretest probability. No patients with 4Ts scores of 2 or less had positive ELISA results.
CONCLUSIONS
HIT can be ruled out in cancer patients (negative predictive value and sensitivity = 100%) with low pretest probability, defined by 4Ts scores of 2 or less, significantly reducing the need for laboratory testing in this patient population.
目的
评估 4Ts 评分（预测试概率评分）在癌症患者中指导肝素诱导的血小板减少症（HIT）实验室筛查检测的应用。
方法
对（n=140）名申请 HIT 实验室检测的患者进行回顾性图表审查。计算 4Ts 评分并与肝素内源性血小板因子 4 抗体酶联免疫吸附测定（ELISA）检测结果相关联。
结果
所有高度疑似 HIT（4Ts 评分=6-7）的患者的 ELISA 检测结果均为阳性，而中高度疑似 HIT（4Ts 评分=4-5）的患者阳性率为 26.1%，低度疑似 HIT（4Ts 评分≤3）的患者阳性率为 4.3%。4Ts 评分≤2 的患者中无一例 ELISA 检测结果阳性。
结论
4Ts 评分≤2 的低预测试概率（阴性预测值和敏感度=100%）可排除癌症患者的 HIT，显著减少此类患者的实验室检测需求。
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