{
  "abstract": "Background\n\nHIT is an anti-platelet factor 4 (PF4) disorder characterized by thrombocytopenia and increased thrombosis risk. The serotonin release assay (SRA) is the gold standard test for diagnosing HIT. The clinical significance of a buffer-positive SRA pattern remains uncertain.Objectives\n\nThis study compared characteristics and outcomes between patients with HIT with buffer-negative and buffer-positive SRA patterns.Methods\n\nWe conducted a retrospective cohort study at the Hospital of the University of Pennsylvania and affiliated hospitals. Consecutive patients with confirmed HIT, defined as a positive PF4/heparin enzyme-linked immunoassay and platelet-rich plasma-based SRA without a high-heparin inhibition step, were classified by an SRA pattern (buffer-negative vs buffer-positive) and followed for 30 days. The primary outcome was cumulative incidence of thrombosis; secondary outcomes included mortality, major bleeding, and platelet recovery.Results\n\nOf 207 HIT-positive patients, 190 (91.8%) had a buffer-negative and 17 (8.2%) had a buffer-positive SRA pattern. Median anti-PF4/heparin enzyme-linked immunoassay optical density was significantly lower in the buffer-positive group (0.8 vs 2.3; P < .001). Thrombosis incidence was similar between groups (64.7% vs 50.2%; P = .28). The buffer-positive pattern was independently associated with longer time to platelet recovery (9.0 vs 5.0 days; P = .03) and higher 30-day cumulative incidence of death (47.4% vs 17.1%; adjusted hazard ratio, 2.74; P = .03).Conclusion\n\nAmong patients with HIT, a buffer-positive SRA pattern was associated with more prolonged thrombocytopenia and increased mortality. Given that our assay used platelet-rich plasma, these findings are hypothesis-generating and require confirmation with the classical washed-platelet SRA.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand",
    "Department of Pathology and Molecular Medicine, Department of Medicine, and McMaster Centre for Transfusion Research, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada",
    "Department of Medicine and Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tarinee Rungjirajittranon"
    },
    {
      "affs": [
        1
      ],
      "name": "Theodore E. Warkentin"
    },
    {
      "affs": [
        2
      ],
      "name": "Adam Cuker"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8pean3vg1gjw1.bib",
  "cited_by": 0,
  "doi": "10.1016/j.rpth.2026.106995",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13717026/?tool=EBI",
  "id": "8pean3vg1gjw1",
  "issns": [
    "2475-0379"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13717026",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2746|Heparin-Induced Thrombocytopenia and Thrombosis"
    ]
  ],
  "openalex": "W7214627134",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13717026/pdf/?tool=EBI",
  "pmcid": "PMC13717026",
  "pmid": "42959281",
  "published": "2026-09-28",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/8pean3vg1gjw1.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:39Z",
      "native_id": "PMC:PMC13717026",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13717026"
    },
    {
      "first_seen": "2026-10-31T12:21:46Z",
      "native_id": "MED:42959281",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42959281"
    },
    {
      "first_seen": "2026-11-02T12:21:25Z",
      "native_id": "PMC13717026",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.rpth.2026.106995"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Heparin-Induced Thrombocytopenia and Thrombosis",
      "subfield": "surgery"
    }
  ],
  "title": "A buffer-positive serotonin release assay pattern is associated with increased mortality in HIT: a retrospective cohort study",
  "title_text": "A buffer-positive serotonin release assay pattern is associated with increased mortality in HIT: a retrospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:21:25Z",
  "url": "https://research.draconitic.com/paper/8pean3vg1gjw1",
  "venue": "Research and practice in thrombosis and haemostasis",
  "versions": []
}