{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T22:43:31Z","timestamp":1783723411775,"version":"3.55.0"},"reference-count":12,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T00:00:00Z","timestamp":1715212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hematology Reports"],"abstract":"<jats:p>Heparin products are frequently used in the inpatient setting to prevent and treat venous thromboembolism, but they simultaneously put patients at risk of developing heparin-induced thrombocytopenia (HIT). The 4Ts score determines the pretest probability of HIT. Diagnosis is made with a screening antiplatelet factor (PF4) immunoassay and the serotonin-release assay (SRA) as a confirmatory test. Anti-PF4 assays have high sensitivity (98%) but lower specificity (50%) and result in frequent false-positive tests. We present a rare case from our institution of a patient with anti-PF4\u2013Polyanion ELISA-negative, SRA-positive HIT and describe the challenges in making a timely diagnosis in this case.<\/jats:p>","DOI":"10.3390\/hematolrep16020029","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T09:22:52Z","timestamp":1715332972000},"page":"295-298","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Anti-PF4 ELISA-Negative, SRA-Positive Heparin-Induced Thrombocytopenia"],"prefix":"10.3390","volume":"16","author":[{"given":"Abraham","family":"Attah","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea","family":"Peterson","sequence":"additional","affiliation":[{"name":"Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4447-1491","authenticated-orcid":false,"given":"Max","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rama","family":"Bhagavatula","sequence":"additional","affiliation":[{"name":"Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deep","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazan","family":"Samhouri","sequence":"additional","affiliation":[{"name":"Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2864","DOI":"10.1182\/blood-2016-11-709873","article-title":"Heparin-induced thrombocytopenia","volume":"129","author":"Arepally","year":"2017","journal-title":"Blood"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.1016\/j.jacc.2016.02.073","article-title":"Heparin-Induced Thrombocytopenia: A Comprehensive Clinical Review","volume":"67","author":"Salter","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1111\/j.1538-7836.2006.01787.x","article-title":"Evaluation of pretest clinical score (4 T\u2019s) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings","volume":"4","author":"Lo","year":"2006","journal-title":"J. Thromb. Haemost."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3360","DOI":"10.1182\/bloodadvances.2018024489","article-title":"American Society of Hematology 2018 guidelines for management of venous thromboembolism: Heparin-induced thrombocytopenia","volume":"2","author":"Cuker","year":"2018","journal-title":"Blood Adv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1160\/TH15-06-0523","article-title":"Diagnostic accuracy of rapid immunoassays for heparin-induced thrombocytopenia. A systematic review and meta-analysis","volume":"115","author":"Sun","year":"2016","journal-title":"Thromb. Haemost."},{"key":"ref_6","first-page":"1171","article-title":"Rapid and Accurate Bayesian Diagnosis of Heparin-induced thrombocytopenia","volume":"135","author":"Marchetti","year":"2020","journal-title":"Blood"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1002\/ajh.26075","article-title":"Serotonin-release assay-positive but platelet factor 4-dependent enzyme-immunoassay negative: HIT or not HIT?","volume":"96","author":"Warkentin","year":"2021","journal-title":"Am. J. Hematol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Tardy, B., Lecompte, T., Mullier, F., Vayne, C., and Pouplard, C. (2020). Detection of Platelet-Activating Antibodies Associated with Heparin-Induced Thrombocytopenia. J. Clin. Med., 9.","DOI":"10.3390\/jcm9041226"},{"key":"ref_9","first-page":"268","article-title":"Use of the ID-PaGIA Heparin\/PF4 Antibody Test as a screening test for heparin\/platelet factor 4 antibodies","volume":"15","author":"Strobel","year":"2017","journal-title":"Blood Transfus."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"153","DOI":"10.2174\/187152907781745251","article-title":"Heparin Induced Thrombocytopenia: Pathogenetic, Clinical, Diagnostic and Therapeutic Aspects","volume":"7","author":"Castelli","year":"2007","journal-title":"Cardiovasc. Hematol. Disord. Targets"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1182\/blood-2002-02-0620","article-title":"Platelet activation induced by human antibodies to interleukin-8","volume":"101","author":"Regnault","year":"2003","journal-title":"Blood"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S0022-2143(99)90005-7","article-title":"Serum-induced platelet procoagulant activity: An assay for the characterization of prothrombotic disorders","volume":"133","author":"Warner","year":"1999","journal-title":"J. Lab. Clin. Med."}],"container-title":["Hematology Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2038-8330\/16\/2\/29\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:42:57Z","timestamp":1760107377000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2038-8330\/16\/2\/29"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,9]]},"references-count":12,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["hematolrep16020029"],"URL":"https:\/\/doi.org\/10.3390\/hematolrep16020029","relation":{},"ISSN":["2038-8330"],"issn-type":[{"value":"2038-8330","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,9]]}}}