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Platelet and monocyte antigenic complexes in the pathogenesis of heparin-induced thrombocytopenia (HIT).

Publication ,  Journal Article
Rauova, L; Arepally, G; McKenzie, SE; Konkle, BA; Cines, DB; Poncz, M
Published in: J Thromb Haemost
July 2009

Heparin-induced thrombocytopenia (HIT) is an iatrogenic disorder that occurs in a small subset of patients receiving heparin. Twenty-five per cent (or higher) of affected patients develop limb or life-threatening thrombosis. The effectiveness of therapy is incomplete and may be complicated by bleeding. HIT is caused by antibodies that recognize the platelet chemokine, Platelet Factor 4 (PF4), complexed to heparin or to cellular glycosaminoglycans (GAGs). However, antibodies with the same apparent specificity are found in many more patients without clinical disease and the reason why so few develop HIT is uncertain. We propose that HIT antibodies recognize cell surface PF4/GAG complexes on intravascular cells, including platelets and monocytes that are dynamic and mutable. Heparin removes cell surface-bound PF4 in most individuals, but removal is incomplete in those with high pre-exposure surface-bound PF4 levels. Such individuals retain critically localized cellular antigenic complexes at the time antibodies develop and are at risk to develop HIT. This article reviews the scientific basis for this model and its clinical implications.

Duke Scholars

Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

July 2009

Volume

7 Suppl 1

Issue

0 1

Start / End Page

249 / 252

Location

England

Related Subject Headings

  • Thrombocytopenia
  • Platelet Factor 4
  • Monocytes
  • Humans
  • Heparin
  • Glycosaminoglycans
  • Cardiovascular System & Hematology
  • Blood Platelets
  • Antibodies
  • 3202 Clinical sciences
 

Citation

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Chicago
ICMJE
MLA
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Rauova, L., Arepally, G., McKenzie, S. E., Konkle, B. A., Cines, D. B., & Poncz, M. (2009). Platelet and monocyte antigenic complexes in the pathogenesis of heparin-induced thrombocytopenia (HIT). J Thromb Haemost, 7 Suppl 1(0 1), 249–252. https://doi.org/10.1111/j.1538-7836.2009.03373.x
Rauova, L., G. Arepally, S. E. McKenzie, B. A. Konkle, D. B. Cines, and M. Poncz. “Platelet and monocyte antigenic complexes in the pathogenesis of heparin-induced thrombocytopenia (HIT).J Thromb Haemost 7 Suppl 1, no. 0 1 (July 2009): 249–52. https://doi.org/10.1111/j.1538-7836.2009.03373.x.
Rauova L, Arepally G, McKenzie SE, Konkle BA, Cines DB, Poncz M. Platelet and monocyte antigenic complexes in the pathogenesis of heparin-induced thrombocytopenia (HIT). J Thromb Haemost. 2009 Jul;7 Suppl 1(0 1):249–52.
Rauova, L., et al. “Platelet and monocyte antigenic complexes in the pathogenesis of heparin-induced thrombocytopenia (HIT).J Thromb Haemost, vol. 7 Suppl 1, no. 0 1, July 2009, pp. 249–52. Pubmed, doi:10.1111/j.1538-7836.2009.03373.x.
Rauova L, Arepally G, McKenzie SE, Konkle BA, Cines DB, Poncz M. Platelet and monocyte antigenic complexes in the pathogenesis of heparin-induced thrombocytopenia (HIT). J Thromb Haemost. 2009 Jul;7 Suppl 1(0 1):249–252.
Journal cover image

Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

July 2009

Volume

7 Suppl 1

Issue

0 1

Start / End Page

249 / 252

Location

England

Related Subject Headings

  • Thrombocytopenia
  • Platelet Factor 4
  • Monocytes
  • Humans
  • Heparin
  • Glycosaminoglycans
  • Cardiovascular System & Hematology
  • Blood Platelets
  • Antibodies
  • 3202 Clinical sciences