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Heparin-induced thrombocytopenia is a complex clinico-biological condition associated with heparin therapy, a true anticoagulant standard, and paradoxically responsible for a major pro-thrombotic state. It represents the most serious iatrogenic complication of heparin therapy, and requires early diagnosis and effective treatment. Its management constitutes a genuine therapeutic emergency, requiring the use of non-heparin antithrombotic agents such as danaparoid sodium and direct thrombin inhibitors to inhibit the hypercoagulability induced by explosive thrombin generation. Biological diagnosis can sometimes be difficult, despite the progress made in understanding the mechanism of the disease and the development of immunological and functional tests that offer diagnostic performance and numerous advantages. One of the most effective functional tests is the radiolabeled serotonin release assay (RAS), historically considered the gold standard.