Thromb Haemost 2000; 84(05): 779-783
DOI: 10.1055/s-0037-1614115
Review Article
Schattauer GmbH

Quantification of Platelet-associated IgG for Differential Diagnosis of Patients with Thrombocytopenia

H. Hagenström
1   From the Institute of Immunology and Transfusion Medicine, University of Lübeck School of Medicine, Germany
,
P. Schlenke
1   From the Institute of Immunology and Transfusion Medicine, University of Lübeck School of Medicine, Germany
,
H. Hennig
1   From the Institute of Immunology and Transfusion Medicine, University of Lübeck School of Medicine, Germany
,
H. Kirchner
1   From the Institute of Immunology and Transfusion Medicine, University of Lübeck School of Medicine, Germany
,
H. Klüter
2   Institute of Transfusion Medicine and Clinical Immunology, Red Cross Transfusion Service of Baden-Württemberg, Mannheim, Germany
› Institutsangaben
We gratefully acknowledge the technical assistance of Bettina Schmitt and Michael Paulsen and thank Ms. Una Doherty for editing the manuscript. We are indebted to Prof. S. Panzer, Vienna, for proof-reading the manuscript.
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Publikationsverlauf

Received 24. Dezember 1999

Accepted after resubmission 30. Mai 2000

Publikationsdatum:
13. Dezember 2017 (online)

Summary

Immune thrombocytopenia is due to platelet destruction by circulating glycoprotein-specific antibodies and is found in various disorders. Methods for the detection of platelet-associated IgG (PAIgG) are generally sensitive but unspecific, whereas glycoprotein-specific assays are highly specific but less sensitive. Usefully, a sensitive screening method for PAIgG detection would also provide information for differential diagnosis. We developed a quantitative direct Platelet Immunofluorescence Test (PIFT) by flow cytometry and studied 79 thrombocytopenic patients with immune thrombocytopenia and other disorders. The sensitivity of the assay was 94%, its specificity 66% for the detection of a clinically obvious immune thrombocytopenia. PAIgG levels of patients with immune thrombocytopenia differed significantly from those of other patients with low platelet counts (p <0.001). The quantitative PIFT proved to be a sensitive method for PAIgG detection and should therefore be used as a screening method. In addition, it could be helpful for differential diagnosis in marked thrombocytopenia where a MAIPA is not feasible.

 
  • References

  • 1 Kurata Y, Hayashi S, Kosugi S, Kashiwagi H, Tomiyama Y, Kanayama Y, Matsuzawa Y. Elevated platelet-associated IgG in SLE patients due to antiplatelet autoantibody: differentiation between autoantibodies and immune complexes by ether elution. Br J Haematol 1993; 85: 723-8.
  • 2 Joutsi L, Kekomaki R. Comparison of the direct platelet immunofluorescence test (direct PIFT) with a modified direct monoclonal antibody-specific immobilization of platelet antigens (direct MAIPA) in detection of platelet-associated IgG. Br J Haematol 1997; 96: 204-9.
  • 3 Macchi L, Rispal P, Clofent SG, Pellegrin JL, Nurden P, Leng B, Nurden AT. Anti-platelet antibodies in patients with systemic lupus erythematosus and the primary antiphospholipid antibody syndrome: their relationship with the observed thrombocytopenia. Br J Haematol 1997; 98: 336-41.
  • 4 Godeau B, Piette JC, Fromont P, Intrator L, Schaeffer A, Bierling P. Specific antiplatelet glycoprotein autoantibodies are associated with the thrombocytopenia of primary antiphospholipid syndrome. Br J Haematol 1997; 98: 873-9.
  • 5 Kelton JG. The serological investigation of patients with autoimmune thrombocytopenia. Thromb Haemost 1995; 74: 228-33.
  • 6 George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, Blanchette VS, Bussel JB, Cines DB, Kelton JG, Lichtin AE, McMillan R, Okerbloom JA, Regan DH, Warrier I. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996; 88: 3-40.
  • 7 Berchtold P, Wenger M. Autoantibodies against platelet glycoproteins in autoimmune thrombocytopenic purpura: Their clinical significance and response to treatment. Blood 1993; 81: 1246-50.
  • 8 Kiefel V, Jager S, Mueller-Eckhardt C. Competitive enzyme-linked immunoassay for the quantitation of plateletassociated immunoglobulins (IgG, IgM, IgA) and complement (C3c, C3d) with polyclonal and monoclonal reagents. Vox Sang 1987; 53: 151-6.
  • 9 von dem AEBorne, Verheugt FW, Oosterhof F, von Riesz E, de la ABRiviere, Engelfriet CP. A simple immunofluorescence test for the detection of platelet antibodies. Br J Haematol 1978; 39: 195-207.
  • 10 Sinha RK, Kelton JG. Current controversies concerning the measurement of platelet-associated IgG. Transfus Med Rev 1990; 04: 121-35.
  • 11 Tazzari PL, Ricci F, Vianelli N, Tassi C, Belletti D, Pierri I, Gugliotta L, Gobbi M, Conte R. Detection of platelet-associated antibodies by flow cytometry in hematological autoimmune disorders. Ann Hematol 1995; 70: 267-72.
  • 12 Janisiw M, Eichelberger B, Koren D, Panzer S. Screening for platelet autoantibodies by flow cytometry and their evaluation by the MAIPA technique. Wien Klin Wochenschr 1998; 110: 531-4.
  • 13 Mueller CEckhardt, Kayser W, Mersch KBaumert, Mueller GEckhardt, Breidenbach M, Kugel HG, Graubner M. The clinical significance of platelet-associated IgG: a study on 298 patients with various disorders. Br J Haematol 1980; 46: 123-31.
  • 14 Kelton JG, Powers PJ, Carter CJ. A prospective study of the usefulness of the measurement of platelet-associated IgG for the diagnosis of idiopathic thrombocytopenic purpura. Blood 1982; 60: 1050-3.
  • 15 Denny TN, Stein D, Mui T, Scolpino A, Holland B. Quantitative determination of surface antibody binding capacities of immune subsets present in peripheral blood of healthy adult donors. Cytometry 1996; 26: 265-74.
  • 16 Kiefel V, Santoso S, Weisheit M, Mueller EC. Monoclonal antibody-specific immobilization of platelet antigens (MAIPA): a new tool for the identification of platelet-reactive antibodies. Blood 1987; 70: 1722-6.
  • 17 Kiefel V. The MAIPA assay and its applications in immunohaematology. Transfus Med 1992; 02: 181-8.
  • 18 Berchtold P, Harris JP, Tani P, Piro L, McMillan R. Autoantibodies to platelet glycoproteins in patients with disease-related immune thrombocytopenia. Br J Haematol 1989; 73: 365-8.
  • 19 Panzer S, Pabinger I, Gschwandtner ME, Mayr WR, Hutter D. Lupus anticoagulants: strong association with the major histocompatibility complex class II and platelet antibodies. Br J Haematol 1997; 98: 342-5.
  • 20 Kluter H, Schlenke P, Muller-Steinhardt M, Paulsen M, Kirchner H. Impact of buffy coat storage on the generation of inflammatory cytokines and platelet activation. Transfusion 1997; 37: 362-7.
  • 21 George JN. Platelet immunoglobulin G: Its significance for the evaluation of thrombocytopenia and for the understanding of the origin of alpha-granule proteins. Blood 1990; 76: 859-70.