Abstract
Heparin anticoagulation is essential during hemodialysis. The frequency of heparin-induced thrombocytopenia (HIT) during the initial phase of dialysis treatment is known to be 3.8%. In North America and Europe, an algorithmic approach to HIT diagnosis including the 4T scoring system has been developed. A standard diagnostic procedure in combination with a screening enzyme immunoassay that detects platelet factor 4/heparin complex antibodies (HIT antibodies) and a confirmatory test using 14C serotonin release assay has been established. In Japan, two chemiluminescence assays and a latex agglutination test have been approved for detecting HIT antibodies in suspected HIT patients. However, there have only been a few published papers about these tests, and their clinical benefit has not been fully elucidated. Also, little is known about how the three tests to contribute to HIT diagnosing in hemodialysis patients, and there is no evidence that the tests have the same ability to diagnose HIT as classical standard of enzyme immunoassays. Therefore, precise assessments of the 4T scoring system are critical for diagnosing HIT before HIT antibody test is performed in hemodialysis patients. In dialysis patients suffering from extracorporeal circuit clotting, an appropriate HIT diagnosis can be obtained by the addition to one point as thrombosis in the 4T scoring system.
