To detect antibodies against the anticoagulant heparin, to help diagnose immune-mediated heparin-induced thrombocytopenia (HIT II)
Heparin-induced Thrombocytopenia PF4 Antibody
Heparin-induced Thrombocytopenia PF4 Antibody
Also Known As
Heparin-PF4 Antibody
HIT Antibody
HIT PF4 Antibody
Heparin Induced Antibody
Heparin Associated Antibody
Formal Name
Heparin-induced Thrombocytopenia Platelet Factor 4 Antibody
This article was last reviewed
on
This article waslast modified
on December 8, 2020.
At a Glance
Why Get Tested?
When To Get Tested?
When you are receiving heparin therapy and your platelet count significantly decreases (thrombocytopenia), especially when you also have new blood clots (thrombosis)
Sample Required?
A blood sample drawn from a vein in your arm
Test Preparation Needed?
None
Accordion Title
Common Questions
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How is the test used?
A test for heparin-induced thrombocytopenia (HIT) antibody, also called heparin-PF4 antibody, is performed to detect antibodies that develop in some people who have been treated with heparin. It is used to help establish a diagnosis of immune-mediated heparin-induced thrombocytopenia (HIT type II) when you have a low platelet count (thrombocytopenia) and excessive clotting (thrombosis).
Even if you have detectable HIT antibodies, you will not necessarily develop HIT II. Therefore, this test is most useful in those with a moderate to high likelihood of having HIT II, based upon the timing of heparin use, significantly low platelet count, and excessive blood clotting. The test is typically ordered along with or following a platelet count and may be followed by additional tests such as functional assays to help confirm a finding.
Functional assays, such as a serotonin release assay or heparin-induced platelet activation assay, are more specific for HIT II but take longer, are more technically demanding, and not widely available. These tests measure the effect your serum has on the function of "normal" platelets from healthy donors.
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When is it ordered?
Since the development of HIT antibodies does not always lead to HIT II, testing is usually ordered only when HIT II is clinically suspected.
There is a pre-test scoring system that is typically used to determine your likelihood of having HIT II. It includes:
- How low your platelet count has dropped (platelet decrease of 50% or more from before you were treated with heparin therapy)
- The timing of the platelet count fall (typically 5-10 days after initial heparin use and within 2 days for a second use within 3 months of previous use)
- The presence of new blood clots (thrombosis) and/or lesions at the heparin injection site
- Ruling out other causes of low platelet count
The HIT antibody test is performed when this pre-scoring test shows that you have a moderate to high likelihood of having HIT II.
Typically, an enzyme immunoassay (EIA) that detects HIT antibody is ordered as an initial test. Functional testing such as a serotonin release assay (SRA) or heparin-induced platelet activation (HIPA) test may be ordered when the EIA test is indeterminate or negative but suspicion of HIT is still high.
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What does the test result mean?
The interpretation of HIT antibody results relies upon testing only people who have a moderate to high probability of having HIT II. Both false negatives and false positives can occur with this test and are more likely if you have a low probability of having HIT II.
If you have HIT antibodies, have been treated with heparin for 5 to 10 days, have a platelet count that has decreased by 50% or more, and have new blood clots, then it is likely that you have HIT II.
If you have HIT antibodies, have received heparin within the last 3 months and are experiencing significant thrombocytopenia within a day or two of re-starting heparin therapy, then it may also indicate HIT II.
If HIT testing is indeterminate, confirmatory testing is positive, and you have clinical signs of HIT, then it is likely that you have HIT II.
If the test is negative for HIT antibodies, then it is unlikely that you have HIT II. If confirmatory testing is performed and it is also negative, then it is likely that your symptoms are due to another cause.
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Does everyone with HIT antibodies develop HIT II?
No. In fact, the majority of people who produce HIT antibodies will not develop HIT II (i.e., have significant thrombocytopenia and thrombosis).
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What else can cause a low platelet count (thrombocytopenia)?
Many conditions and diseases other than HIT can cause thrombocytopenia by affecting your platelet production or increasing platelet loss (destruction). In addition to heparin, there are several other medications that can cause drug-induced thrombocytopenia and antiplatelet antibodies. For more details, read the article on Low Platelets.
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What is HIT type I and how does it differ from HIT type II?
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Does the type and/or amount of heparin I receive make a difference in my risk for developing HIT?
There are two types of heparin that may be used in your treatment: standard or unfractionated heparin (UFH) and low-molecular weight heparin (LMWH). HIT II can develop in anyone receiving UFH but is more likely in those who have had surgery. The condition is rare in children. Low molecular weight heparin (LMWH) does not generally cause HIT II, but it can. If you have developed HIT II with UFH, then you are more likely to develop HIT with LMWH.
It is rare but possible for you to develop HIT antibodies, even when the only heparin that you have been exposed to is the small amount used to flush out your intravenous line or catheter.
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Can the heparin-induced thrombocytopenia (HIT) antibody test be done in my healthcare practitioner's office?
No. It requires specialized equipment and is not offered by every hospital-based laboratory. It may be necessary to send your blood sample to a reference laboratory.
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If I have an HIT antibody, will it eventually go away?
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How long is someone usually treated with heparin?
In most cases, you would be on heparin for a short period of time and then transitioned to another anticoagulant (e.g., oral Coumadin). Pregnant women who need anticoagulation may receive low molecular weight heparin (LMWH) for extended periods of time.
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Should I tell all of my healthcare practitioners that I have an HIT antibody?