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Nielsen OH, Tuckuviene R, Nielsen KR, Rosthøj S. Flow cytometric measurement of platelet-associated immunoglobulin in children with newly diagnosed Immune Thrombocytopenia. Eur J Haematol 2015; 96:397-403. [PMID: 26111053 DOI: 10.1111/ejh.12605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the clinical utility of measuring platelet-associated immunoglobulin (PAIG) at the time of diagnosis in children with immune thrombocytopenia (ITP). METHODS PAIG was measured by flow cytometry using fluorescent murine anti-IgG and anti-IgM. In a cohort of 88 children with ITP, the assay was performed within 15 days of diagnosis and before any treatment in 68 cases. We reviewed the results and examined the relation of isotype profile and degree of elevation to clinical manifestations and course of disease. RESULTS PAIG was elevated in 74%, with raised IgM being more frequent than IgG (63% vs. 44%, P = 0.04) and with isotype profile depending on symptom onset. Platelet counts at presentation were similar in all subgroups, but mucosal bleeding was less frequent in PAIG-negative patients compared to the positive groups (5.5% vs. 34%, P = 0.03). Duration of thrombocytopenia was similar in negative and positive cases, but during follow-up, significant bleeding events occurred less frequently in PAIG-negative patients (0% vs. 14%, P = 0.18). CONCLUSION Approximately one-quarter of children are PAIG-negative, and these children have milder bleeding tendency at diagnosis and lower morbidity during follow-up. Raised PAIG possibly may cause some degree of platelet dysfunction.
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Affiliation(s)
| | - Ruta Tuckuviene
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Steen Rosthøj
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
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2
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Kayser W, Mueller-Eckhardt C, Bhakdi S, Ebert K. Platelet-associated complement C3 in thrombocytopenic states. Br J Haematol 2008. [DOI: 10.1111/j.1365-2141.1983.00353.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Han P, Kiruba R, Ho YC. Platelet-associated immunoproteins (PAIg): specificity of measurement. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 12:49-56. [PMID: 2344716 DOI: 10.1111/j.1365-2257.1990.tb01110.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Platelet-associated Ig (PAIg) is raised in patients with idiopathic thrombocytopenic purpura. However, it is also raised in conditions not traditionally considered to be immune mediated. The latter finding suggests that raised PAIg may be an epiphenomenon of thrombocytopenia. The assays currently available do not distinguish between PAIg present due to a specific Fab binding or present due to non-specific binding of Ig via Fc or complement receptors. In this paper we show that by prior incubation with normal rabbit serum, an assay for PAIg can be made specific for Fab binding.
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Affiliation(s)
- P Han
- Haematology Clinical Laboratories, National University Hospital, Singapore
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4
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Taaning E, Petersen S. Pattern of platelet-associated immunoglobulin (classes and IgG subclasses) in childhood immune thrombocytopenic purpura. Eur J Haematol 1988; 41:449-53. [PMID: 3208868 DOI: 10.1111/j.1600-0609.1988.tb00226.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Platelet-associated Ig classes and IgG subclasses were studied by a semiquantitative platelet ELISA test in 17 children with immune thrombocytopenic purpura (ITP). An elevation of PAIg was found in 94% of the children. In nearly all cases increased amounts of PAIgG of subclass G1 was seen, and in half of the cases increased amounts of PAIgM were also seen. No statistical difference in the composition of PAIg classes and PAIgG subclasses in acute and in chronic ITP was found. However, a correlation of increased amount of PAIgG3 and very low platelet count (20 x 10(9)/l) was observed.
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Affiliation(s)
- E Taaning
- Department of Clinical Immunology, Glostrup Hospital, University of Copenhagen, Denmark
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5
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Kiefel V, Jäger S, Mueller-Eckhardt C. Competitive enzyme-linked immunoassay for the quantitation of platelet-associated immunoglobulins (IgG, IgM, IgA) and complement (C3c, C3d) with polyclonal and monoclonal reagents. Vox Sang 1987; 53:151-6. [PMID: 3318121 DOI: 10.1111/j.1423-0410.1987.tb04940.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A competitive enzyme-linked immunoassay (CELIA) was developed for the quantitation of platelet-associated immunoglobulins and complement proteins. The use of unlabeled polyclonal rabbit or monoclonal antibodies to human immunoglobulins and enzyme-labeled anti-mouse or anti--rabbit IgG (double-step technique) resulted in a higher sensitivity compared to the single-step technique using only enzyme-labeled anti-human immunoglobulin antibody preparations. Sensitivity and results obtained by both techniques were compared. The range of normal values for platelet-associated IgG, IgM, IgA, C3c and C3d was assessed upon a large number of normal blood donors. When platelet-associated IgG was concomitantly assayed with polyclonal and monoclonal anti-IgG by the double-step technique on platelets obtained from normal donors and thrombocytopenic patients, identical results were obtained with both reagents. Problems related to the quantitation of immunoglobulins on platelets with different assays and antibody preparations are discussed.
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Affiliation(s)
- V Kiefel
- Institute of Clinical Immunology and Blood Transfusion, Justus Liebig University, Giessen, FRG
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6
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Henke M, Engler H, Engelhardt R, Löhr GW. Successful therapy of sarcoidosis-associated thrombocytopenia refractory to corticosteroids by a single course of human gammaglobulins. KLINISCHE WOCHENSCHRIFT 1986; 64:1209-11. [PMID: 3807267 DOI: 10.1007/bf01728464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Thrombocytopenia developed in a 21-year-old patient with sarcoidosis when corticosteroid therapy was discontinued. Platelet-associated IgGs were elevated. High-dose cortisone did not affect the thrombocytopenia. However, platelet counts remained normal for more than 1.5 years following intravenous treatment with a single course of human gammaglobulins.
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7
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Fabris F, Casonato A, Randi ML, Luzzatto G, Girolami A. Clinical significance of surface and internal pools of platelet-associated immunoglobulins in immune thrombocytopenia. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 1986; 37:215-20. [PMID: 3787173 DOI: 10.1111/j.1600-0609.1986.tb02300.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We have investigated serum platelet bindable IgG(SPBIgG) and platelet-associated IgG(PAIgG) in patients with immune thrombocytopenia (IT) to ascertain the significance of the larger amounts of PAIgG reported both in normals and in patients using homogenized (Total:T-PAIgG) instead of intact platelets (Surface:S-PAIgG). 12 patients, during active immune thrombocytopenia (A-IT), and 18 patients in steroid-induced remission (S-IT), were studied. As control we considered 20 patients with non-immune thrombocytopenia (N-IT) and 29 subjects with normal platelet count. The average positivity of SPBIgG was 41% with a higher percentage in A-IT (66%) than in S-IT (16%). The results of PAIgG also indicate a different behaviour in A-IT and S-IT of surface and cytoplasmatic pools. During A-IT both pools are enhanced with prevalence towards the surface one (S-PAIgG). On the contrary, during steroid-induced remission, despite the normal amount of the S-PAIgG present the internal pool still increases, indicating a steady-state of IT and the possible existence of a platelet phagocytic activity.
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8
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Kiefel V, Spaeth P, Mueller-Eckhardt C. Immune thrombocytopenic purpura: autoimmune or immune complex disease? Br J Haematol 1986; 64:57-68. [PMID: 2944539 DOI: 10.1111/j.1365-2141.1986.tb07573.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To assess the pathogenic role of circulating immune complexes (CIC) in idiopathic thrombocytopenic purpura (ITP), 39 patients with ITP were compared to 17 patients with other forms of thrombocytopenia (hypersplenism (N = 12), impaired thrombopoiesis (3), thrombocytopenia of unknown origin (2)) and six nonthrombocytopenic subjects. In all patients, platelet mean life span (MLS), platelet associated IgG (PAIgG), as well as circulating anti-platelet antibodies and C1q binding activities were determined. In most cases, immune complex solubilization capacity (ICSC) and immune complex precipitation inhibition capacity (ICPIC) of sera were also assessed. All patients with ITP had a reduced platelet MLS, but PAIgG was elevated in only 16 out of 24 patients with chronic ITP, in six out of 10 patients with acute ITP and in four out of five patients with secondary ITP. In the group of patients with thrombocytopenia due to splenomegaly, seven out of 12 patients had elevated PAIgG while the platelet MLS was only slightly reduced. Of the 39 patients with ITP only one with secondary ITP had C1q binding material in his serum, as opposed to six out of 12 thrombocytopenic patients with splenomegaly. Whereas only three patients with ITP had abnormal immune-complex modulating capacities, such deviations were found in seven out of 12 patients with thrombocytopenia due to splenomegaly. We conclude that our data render the role of CIC in the pathogenesis of ITP very questionable.
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9
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Schwartz KA, Royer G, Kaufman DB, Penner JA. Complications of heparin administration in normal individuals. Am J Hematol 1985; 19:355-63. [PMID: 4025314 DOI: 10.1002/ajh.2830190406] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The incidence, severity, and pathogenic mechanism of heparin-associated thrombocytopenia with both bovine and porcine heparin administration were studied in forty normal males randomized to one of four treatment groups: beef lung heparin #1, beef lung heparin #2, porcine gut heparin, and saline control. All of the subjects receiving heparin developed a reversible increase in serum transaminases (SGOT, SGPT). However, other measurements of liver function were normal. Thirty-three percent of these heparinized normals had decreased platelet counts. The incidence of platelet count decrease was similar for both bovine and porcine heparins, but 4 of the 20 normals receiving bovine heparin had platelet counts less than 150,000/microliters. Immune pathogenesis was investigated by analyzing plasma from the volunteers for both platelet antibody and immune complexes. None of the men had increased platelet-associated IgG. Among the ten subjects with decreased platelet counts, IgG immune complexes were detected in three and C1q in seven. The heparin-associated thrombocytopenia appears not to be mediated by a platelet antibody. More probably it reflects a direct effect of the heparin on platelets.
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10
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Seifried E, Pindur G, Stötter H, Wiesneth M, Rasche H, Heimpel H. Treatment of refractory chronic idiopathic thrombocytopenic purpura with high dose intravenous immunoglobulin. ACTA ACUST UNITED AC 1984; 48:369-76. [PMID: 6540131 DOI: 10.1007/bf00319965] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Three patients with a history of chronic idiopathic thrombocytopenic purpura stretching back over 20 years are reported. Despite splenectomy and immunosuppressive therapy satisfactory control of their disease has not been achieved. They had remained refractory to all therapeutic manoeuvres with corticosteroids and immunosuppressives for years with thrombocyte counts between 5,000 and 25,000/microliters and the concommitant risk of bleeding. This report describes the treatment of bleeding complications in these patients with high dose intravenous immunoglobulin; the peripheral blood thrombocyte count increased in all three patients from subnormal towards normal, but 2 to 4 weeks later returned to its initial low value. During the therapeutically induced raised thrombocyte count a normal bleeding time and only a moderate inhibition of thrombocyte adhesion and aggregation was observed resulting in reasonable haemostasis. High dose intravenous immunoglobulin is therefore a practical method for the control of bleeding complications in patients with refractory chronic idiopathic thrombocytopenic purpura. A clear explanation for its mode of action has not been found - the lymphocyte subpopulations remained unchanged and immunoglobulin production in vitro during the course of treatment was only minimally decreased.
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11
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Küenzlen E, Bauer J, Bertram U, Becker T, Lampert F, Röttger P, Mueller-Eckhardt C. Fatal outcome of acute thrombocytopenic purpura associated with a viral infection in an 11-year-old child. ACTA ACUST UNITED AC 1984; 48:363-7. [PMID: 6540130 DOI: 10.1007/bf00319964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A case of fatal intracranial hemorrhage is reported in an eleven year old girl with acute idiopathic thrombocytopenic purpura following a viral infection. The patient was randomized to the IgG-arm of the ITP therapy study. Immunoglobulin administration was not followed by a raise of the thrombocyte count. Neither the IgG therapy nor intensive therapeutic measurements were able to prevent the fatal course of cerebral hemorrhage in this case. Pathological and immunological findings indicate that our patient suffered from a fulminant ITP which must be considered as a part of a still active viral disease.
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12
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Helmerhorst FM, ten Berge ML, van der Plas-van Dalen CM, Engelfriet CP, von dem Borne AE. Platelet freezing for serological purposes with and without a cryopreservative. Vox Sang 1984; 46:318-22. [PMID: 6375132 DOI: 10.1111/j.1423-0410.1984.tb00092.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We compared the reactivity of fresh platelets with platelets frozen in dimethylsulfoxide (DMSO) or without a cryopreservative by testing agglutinating and non-agglutinating platelet-specific alloantibodies in titration. Frozen platelets, irrespective of the method of preservation, showed no loss of antigenicity as compared with fresh platelets. The yield of platelets frozen without a cryopreservative proved to be higher (80%) than platelets frozen in the presence of DMSO (50%). Platelets sensitized with autoantibodies from patients with autoimmune thrombocytopenia could also be stored by simple freezing in platelet-rich plasma and used for (re)testing.
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13
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Schmidt RE, Budde U, Bröschen-Zywietz C, Schäfer G, Mueller-Eckhardt C. High dose gammaglobulin therapy in adults with idiopathic thrombocytopenic purpura (ITP). Clinical effects. BLUT 1984; 48:19-25. [PMID: 6197117 DOI: 10.1007/bf00320713] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study of the effect of high-dose intravenous gammaglobulins with one or two courses of therapy in 18 adults with idiopathic thrombocytopenia purpura showed a platelet rise in thirteen patients. The highest response rates were seen in splenectomized adults. In chronic patients the response was transient only. If therapy was effective, increased values of platelet-associated IgG were reduced, while shortened platelet survival times were prolonged. There was no influence of high-dose gammaglobulins on platelet function. different 7S-preparations such as beta-propiolactone modified Ig, pH 4 treated Ig and reduced and alkylated Ig have comparable effects.
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14
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Freedman J, Hooi C, Garvey MB. Prospective platelet crossmatching for selection of compatible random donors. Br J Haematol 1984; 56:9-18. [PMID: 6367808 DOI: 10.1111/j.1365-2141.1984.tb01267.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
An indirect platelet radioactive antiglobulin test was used in a prospective crossmatch study in 29 patients for selecting compatible random donors for platelet transfusion. Patients received crossmatch-compatible, crossmatch-incompatible and uncrossmatched platelets. A successful outcome for transfusion was defined as a 24 h post-transfusion corrected platelet increment of greater than 4.5 X 10(9)/l. Of 47 predictions based on crossmatch results, the technique successfully predicted the outcome of the transfusion in 90% of cases. In all patients, transfusion of crossmatch-compatible platelets resulted in a significantly higher 24 h corrected platelet increment than was obtained following transfusion of incompatible platelets. The mean +/- SEM 24 h corrected post-transfusion increment (X 10(9)/l) was 17.79 +/- 2.01 in 26 patients who received crossmatch-compatible pooled random donor platelets; in 21 patients who received crossmatch-incompatible platelets, it was 1.19 +/- 0.56; and in 25 patients who received uncrossmatched platelets, 4.42 +/- 0.97. The differences were highly significant. There was an 83% correlation of results with those obtained using an indirect platelet suspension immunofluorescence technique.
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15
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Helmerhorst FM, Smeenk RJ, Hack CE, Engelfriet CP, von dem Borne AE. Interference of IgG, IgG aggregates and immune complexes in tests for platelet autoantibodies. Br J Haematol 1983; 55:533-45. [PMID: 6357267 DOI: 10.1111/j.1365-2141.1983.tb02168.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Three techniques, based on the antiglobulin principle, used for the detection of autoantibodies against platelets, were compared; the antiglobulin consumption assay (QACA), the platelet radioactive antiglobulin test (PRAT) and the platelet suspension immunofluorescence test (PSIFT). Upon incubation of normal donor platelets with purified IgG, in concentrations higher than that in serum, an increased amount of platelet-associated IgG was demonstrated only in the QACA. Upon incubation with aggregated IgG, all three tests became positive, but the PSIFT only with high concentrations of aggregates. Binding of soluble C1q-binding immune complexes (IC), which consisted of tetanus toxoid and IgG antitetanus antibodies (TaT) to normal donor platelets, was only detectable in the QACA. However, a positive result was obtained in all three tests with platelets incubated with soluble DNA-IgG-antiDNA antibodies (DaD) IC. Fixation of the platelets with paraformaldehyde prevented the binding and the detection of the DaD-IC, but not of IgG, aggregated IgG or TaT-IC. Eluates from platelets incubated with aggregated IgG, TaT- or DaD-IC did not react with normal donor platelets in the three techniques, in contrast to eluates from platelets sensitized with platelet antibodies.
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16
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Kayser W, Mueller-Eckhardt C, Bhakdi S, Ebert K. Platelet-associated complement C3 in thrombocytopenic states. Br J Haematol 1983; 54:353-63. [PMID: 6602625 DOI: 10.1111/j.1365-2141.1983.tb02110.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Platelet-associated complement components C3, C3d and C4 (PAC3, PAC3d, PAC4) were quantitated by a modification of the platelet radioactive anti-IgG test using highly purified C3 antibodies in 74 patients with immune thrombocytopenia (ITP), 26 patients with presumed nonimmune thrombocytopenia (NTP), and 114 normal individuals. Elevated PAC3 levels were found in 26 out of 74 patients with ITP (35%) and in 10 out of 26 patients with NTP. Although the percentage of elevated PAC3 values was higher in thrombocytopenic patients than in nonthrombocytopenic patients, no statistically significant correlation existed between platelet counts and PAC3 levels, neither for ITP nor for NTP. However, such a relationship was demonstrable between PAC3 and platelet-associated IgG, both for ITP (P less than 0.05) as well as NTP patients (P less than 0.001). We conclude that elevated PAC3 values are not restricted to immune thrombocytopenias. Quantitative differences of PAC3 between ITP and NTP patients suggest that part of the PAC3 is immunologically mediated and has a role in the pathogenesis of autoimmune thrombocytopenias.
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17
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Wenske C, Gaedicke G, Küenzlen E, Heyes H, Mueller-Eckhardt C, Kleihauer E, Lauritzen C. Treatment of idiopathic thrombocytic purpura in pregnancy by high-dose intravenous immunoglobulin. BLUT 1983; 46:347-53. [PMID: 6189536 DOI: 10.1007/bf00320695] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
ITP in pregnancy may lead to fetal thrombocytopenia caused by the transplacental passage of maternal antiplatelet antibody. The most hazardous complication in the infant is intracranial hemorrhage. In addition ITP in pregnancy is reported to be associated with an increased abortion rate and an elevated fetal morbidity and mortality. Therefore obstetric management must aim at increasing maternal and fetal platelets. Several therapeutic approaches to the treatment of ITP in pregnancy are evaluated. Two cases of ITP in pregnancy are reported. Administration of high-dose intravenous immunoglobulin is introduced as a new therapy for ITP in pregnancy. The rapid reversal of thrombocytopenia following immunoglobulin G administration suggests that it is useful especially as emergency treatment for ITP in pregnancy.
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18
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Kayser W, Mueller-Eckhardt C, Mueller-Eckhardt G. The value of platelet-associated IgG in predicting the efficacy of splenectomy in autoimmune thrombocytopenia. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 1983; 30:30-5. [PMID: 6682240 DOI: 10.1111/j.1600-0609.1983.tb00631.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In a prospective study, the hypothesis of whether the quantitative determination of platelet-associated IgG (PAIgG) in patients with chronic autoimmune thrombocytopenic purpura (ATP) can predict the efficacy of splenectomy, was investigated. PAIgG levels were repeatedly determined in 16 patients with definite ATP pre- and postsplenectomy, and related to platelet counts and platelet mean life span. It was found that patients with an immediate remission after splenectomy tended to have lower PAIgG levels (less than 6%) than failures, but this difference was not statistically significant. We conclude that PAIgG is of limited value for the prediction of the efficacy of splenectomy in ATP.
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Follea G, Mandrand B, Dechavanne M. Simultaneous enzymo-immunologic assays of platelet associated IgG, IgM and C3. A useful tool in assessment of immune thrombocytopenias. Thromb Res 1982; 26:249-58. [PMID: 7051415 DOI: 10.1016/0049-3848(82)90289-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A solid phase enzymo-immunologic assay (EIA) has been developed to measure platelet associated (PA) IgG, IgM and C3. Washed platelets are mixed with a goat anti-IgG (IgM or C3) antiserum and then incubated in serum coated polystyrene plates. There is an inverse relationship between the level of PA IgG (IgM or C3) and the amount of goat antibodies binding to the IgG (IgM or C3) coating the plates. These goat antibodies are detected by addition of a phosphatase-labelled sheep anti-goat immunoglobulins antibody followed by a substrate giving a colour reaction. Using this technique, platelets from normal donors gave values of 2.04 +/- 1.10 fg IgG/platelet (mean +/- SD), 8.66 +/- 2.61 x 10(-16) g IgM/platelet and 5.67 +/- 2.63 x 10(-16) g C3/platelet. In 35 thrombocytopenic ITP patients we observed an increased level of PA IgG in 25, of PA IgM in 24 and of PA C3 in 23, and all of them had at least an increase of one of the 3 components. In 10 ITP patients in remission, 2 had an increased level of PA IgG while PA IgM and C3 values were normal in all. On the other hand, 2 non thrombocytopenic patients with systemic lupus erythematosus had an increased level of PA IgM. Compared to the standard antiglobulin consumption assay (ACA), the EIA was simpler to perform and more sensitive.
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20
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Schwartz KA, Slichter SJ, Harker LA. Immune-mediated platelet destruction and thrombocytopenia in patients with solid tumours. Br J Haematol 1982; 51:17-24. [PMID: 7073988 DOI: 10.1111/j.1365-2141.1982.tb07285.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Autoimmune mediated platelet destruction with severe thrombocytopenia was documented in eight patients with solid tumours. The patients had reduced platelet lifespan, positive platelet antibody tests, increased numbers of megakaryocytes, and a rise in platelet count following treatment with steroids, splenectomy or immunosuppressive therapy. Intravascular coagulation was excluded as the predominant cause of thrombocytopenia by near normal 125I-fibrinogen survival; thrombocytopenia secondary to marrow suppression was ruled out by increased platelet turnover. Thus, like patients with lymphoproliferative disorders, patients with solid tumours may be thrombocytopenic because of immune mediated platelet destruction.
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21
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Helmerhorst FM, van Leeuwen EF, Pegels JG, van der Plas-van Dalen C, Eengelfriet CP, von dem Borne AE. Primary and secondary autoimmune thrombocytopenia. A serological and clinical analysis. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 1982; 28:319-28. [PMID: 7112030 DOI: 10.1111/j.1600-0609.1982.tb00533.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In 357 thrombocytopenic patients, the autoimmune nature of the thrombocytopenia was established with the immunofluorescence test on paraformaldehyde-fixed platelets in suspension (PSIFT). In 142 patients, autoimmune thrombocytopenia (AITP) was accompanied by (an)other disease(s) and thus classified as secondary AITP. No significant difference was found in the distribution of the immunochemical characteristics of the autoantibodies between primary and secondary AITP. The results of survival studies with 51Cr-labelled platelets and organ sequestration measurements in 7 patients with idiopathic thrombocytopenia purpura (ITP) indicated that platelets with IgM autoantibodies were sequestered mainly in the spleen. An increased incidence of AITP was seen at 5 to 10 years of age, in the 3rd decade and in the 6th and 7th decades of life. AITP was slightly more common life in females. The following groups of accompanying diseases in 142 AITP patients were distinguished: autoimmune diseases of the blood, malignant diseases of the blood, generalized and organ-specific autoimmune diseases, carcinoma and a miscellaneous group of diseases. No significant differences were found in the immunochemical properties of the autoantibodies between the various categories of disease. In 7 cases, AITP was preceded by an established viral disease, in 1 case by lepra and in another by a vaccination. The PSIFT was found to be a suitable test for diagnosing AITP not only in idiopathic thrombocytopenia, but also in thrombocytopenia associated with another disease.
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22
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Doughty R, James V, Magee J. An enzyme linked immunosorbent assay for leucocyte and platelet antibodies. J Immunol Methods 1981; 47:161-9. [PMID: 7320510 DOI: 10.1016/0022-1759(81)90116-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
An enzyme linked immunosorbent assay (ELISA) method for the detection of antibodies to platelets and leucocytes is presented. The method can be used for large numbers of samples. The method is objective when photometers are used. Approximately 50% of all cases of possible autoimmune thrombocytopenic purpura (A.T.P.) and unexplained neutropenia showed positive results. The results obtained using ELISA and standard tests for leucocyte and platelet antibodies are compared. The ELISA tests may also detect immune complexes.
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23
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Hegde UM, Bowes A, Powell DK, Joyner MV. Detection of platelet-bound and serum antibodies in autoimmune thrombocytopenia by enzyme-linked assay. Vox Sang 1981; 41:306-12. [PMID: 7034370 DOI: 10.1111/j.1423-0410.1981.tb01054.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Platelet antibodies were looked for in 47 patients with autoimmune thrombocytopenia using a modification of the enzyme-linked assay previously described. Surface-bound antibodies measured as increased platelet-associated IgG were found in 32 (68%) of the patients. After incubation in test sera, the platelet-associated IgG of normal donor platelets was significantly increased in 27 of the 47 patients (57%), thus demonstrating the presence of platelet antibodies free in their sera. 6 patients had antibodies only in the serum without any elevation of their platelet-associated IgG. When both tests are evaluated together no antibody was detected by either the direct or the indirect test in 9 of the 47 patients (29%) studied. The technique used is described and the interpretation of our results discussed.
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Mulshine J, Lucas FV, Clough JD. Platelet-bound IgG in systemic lupus erythematosus with and without thrombocytopenia. J Immunol Methods 1981; 45:275-81. [PMID: 7288196 DOI: 10.1016/0022-1759(81)90305-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A new assay for IgG bound to autologous platelets is described, in which IgG is dissociated from platelets washed at low pH, then measured by radioimmunoassay. Platelet-bound IgG was found to be elevated in thrombocytopenic patients with SLE and reduced in non-thrombocytopenic patients with this disease. There was a close inverse correlation of platelet-bound IgG and platelet count. Immune complexes did not interfere with the assay.
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25
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26
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Hegde UM, Powell DK, Bowes A, Gordon-Smith EC. Enzyme linked immunoassay for the detection of platelet associated IgG. Br J Haematol 1981; 48:39-46. [PMID: 7248190 DOI: 10.1111/j.1365-2141.1981.00039.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
An enzyme linked immunoassay incorporating antihuman globulin coupled with alkaline phosphatase has been developed to measure platelet associated IgG (PAIgG). Using a method in which platelet IgG is extracted into the fluid phase after appropriate procedures, we were able to bind the 'solubilized' PAIgG to commercially obtained antihuman IgG (AHG) which had previously been coated onto polystyrene. The amount of PAIgG thus bound was subsequently measured by the addition of the enzyme reagent using p-nitro phenyl phosphate as substrate. With this technique platelets from normal donors were found to have 2.6-17.4 ng/10(6) platelets (mean +/-2 SD). These values are higher than those obtained when assay systems using intact platelets are employed. Platelets from patients with immune thrombocytopenia had PAIgG values of 8.2-98.0 ng/10(6) platelets. In a few patients with disorders other than autoimmune thrombocytopenia (AITP) increased levels of PAIgG were also demonstrated. The assumption that increased PAIgG always represents platelet autoantibody may not be valid. The relevance of PAIgG as a parameter in the diagnosis and clinical management of patients with AITP is discussed.
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van Leeuwen EF, von dem Borne AE, van der Plas-van Dalen C, Engelfriet CP. Idiopathic thrombocytopenic purpura in children; detection of platelet autoantibodies by immunofluorescence. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 1981; 26:285-91. [PMID: 7038843 DOI: 10.1111/j.1600-0609.1981.tb01663.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There are 3 varieties of idiopathic thrombocytopenic purpura (ITP) in children: the acute, the chronic and the recurrent forms. We have tested the platelets from 80 children with these forms of ITP by an immunofluorescence test. Platelet-bound immunoglobulins were detected in 19/22 acute, 41/48 chronic and 5/10 recurrent cases of ITP, i.e. in 65 of a total of 80 cases. A significance differences between acute and chronic ITP was found in the observation that only IgM was bound to the platelets of 7/16 patients with acute ITP. In all cases of chronic ITP with a positive direct immunofluorescence test, IgG was present on the platelet membrane. It is assumed because some patients with chronic ITP do not have elevated platelet-bound immunoglobulins, and show refractoriness to immunosuppressive therapy, that in these patients the disorder is not of a humoral autoimmune nature.
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Sandler RM, Voak D, Darnborough J. A simple method for detecting complement-fixation by autologous platelets in autoimmune thrombocytopenic purpura. CLINICAL AND LABORATORY HAEMATOLOGY 1981; 3:61-70. [PMID: 7194758 DOI: 10.1111/j.1365-2257.1981.tb01310.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A new modification of the microtitre complement fixation test, (CFT), is described for the detection of platelet-bound antibodies (PBA). The test was positive in 12 out of 16 patients, (75%), with active autoimmune thrombocytopenic purpura (AITP). It was negative in four patients who were in remission of AITP when tested, in 10 patients with non-immune thrombocytopenia and in 51 normal blood donors. This is a semi-quantitative method in which suspensions of the patients' own platelets consume complement and therefore prevent the lysis of sensitised sheep red cells (SRBC). Sera from some of these cases were also tested for serum anti-platelet antibody (SPA) and immune complexes. The possible mechanisms and the relevance of positive results are discussed.
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29
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Mueller-Eckhardt C, Kayser W, Mersch-Baumert K, Mueller-Eckhardt G, 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. [PMID: 7191717 DOI: 10.1111/j.1365-2141.1980.tb05942.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Platelet-associated IgG (PAIgG) was studied by a quantitative platelet radioactive anti-IgG test (PRAT) in 298 patients. At the time of investigation, 171 patients were thrombocytopenic (platelet count < 100 X 10(9)/l), 127 had normal platelet counts. Patients fell into the following disease categories: Idiopathic thrombocytopenic purpura (ITP) (N = 81), possible ITP (19), acute ITP (9), systemic lupus erythematosus (22), autoimmune haemolytic anaemia of warm-type (18), systemic blood disease (65), liver diseases (35), other (49). A significant elevation of PAIgG was found in all disease categories. There was a significant correlation between PAIgG and the reciprocal values of platelet counts for most disease groups. No relationship was discernible between PAIgG and hypergammaglobulinaemic states (serum IgG > 1.8 g/l). Platelet survival studies (N = 30) revealed that normal and increased values of PAIgG were associated with normal or shortened platelet mean life span. It is concluded that an elevated PAIgG is only one of several factors involved in the development of immunologically medicated thrombocytopenia.
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Mueller-Eckhardt G, Breidenbach M, Mahn I, Mueller-Eckhardt C. The role of alloimmunization in platelet survival studies. BLUT 1980; 41:93-9. [PMID: 7437528 DOI: 10.1007/bf01039653] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The role of platelet alloimmunization in the survival of 51Cr-labeled allogeneic platelets was investigated in 89 patients with severe thrombocytopenias. The serological analysis included HLA typing of patients, screening of their sera in the lymphocytotoxicity test (LCTT), the platelet complement fixation test (PCFT), and the platelet radioactive anti-IgG test (PRAT; N = 38). Platelet donors were selected according to the best available HLA match and crossmatch in LCTT. Alloantibodies against HLA antigens were found in the sera of 17 patients (19.1%). No platelet-specific alloantibodies were detected. The use of compatible, allogeneic platelets permitted the discrimination of diminished platelet production from increased platelet turnover in thrombocytopenic patients with proven alloimmunization. Our results stress the necessity of a serological workup prior to platelet survival studies.
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Sugiura K, Steiner M, Baldini M. Charcterization and measurement of normal platelet-associated immunoglobulin G by fluorospectrophotometry. BIOCHIMICA ET BIOPHYSICA ACTA 1980; 631:166-76. [PMID: 7397243 DOI: 10.1016/0304-4165(80)90064-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Platelet-associated immunoglobulin G of normal healthy subjects was measured and its binding characteristics studied by use of a newly developed assay which is rapid, quantitative, sensitive and inexpensive. The assay is based on fluorospectrophotometry. Fluorescein isothiocyanate was used as a fluorescent marker to label IgG. Measurement of platelet-associated IgG by this method showed that normal platelets have at least two types of binding sites for IgG of normal healthy subjects. High- and low-affinity binding sites numbering 410 +/- 200 and 1800 +/- 500, respectively, were identified. Specificity of binding was shown by competition between fluorescein isothiocyanate-labeled IgG and nonlabeled IgG. The effect of pH and temperature and the kinetics of binding were also investigated.
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32
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Helmerhorst FM, Bossers B, de Bruin HG, Engelfriet CP, von dem Borne AE. Detection of platelet antibodies: a comparison of three techniques. Vox Sang 1980; 39:83-92. [PMID: 7025447 DOI: 10.1111/j.1423-0410.1980.tb01842.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
For the detection of auto-antibodies on the platelets and in the serum of patients with idiopathic thrombocytopenic purpura, three new techniques have recently been developed: the quantitative antiglobulin consumption assay (QACA), the platelet radioactive antiglobulin test (PRAT) and the platelet suspension immunofluorescence test (PSIFT). The results obtained by various investigators with these techniques differ considerably. We, therefore, studied the sensitivity of the three methods. This was done by testing platelet-reactive allo-antibodies (anti-Zwa, anti-HLA-A2) and auto-antibodies in titration. The results show that the PSIFT is the most sensitive technique, closely followed by the PRAT. The QACA was found to be much less sensitive than the other two methods. This suggests that a positive result in the QACA and a negative result in the PSIFT and/or PRAT cannot be attributed to the presence of platelet auto-antibodies.
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von dem Borne AE, Helmerhorst FM, van Leeuwen EF, Pegels HG, von Riesz E, Engelfriet CP. Autoimmune thrombocytopenia: detection of platelet autoantibodies with the suspension immunofluorescence test. Br J Haematol 1980; 45:319-27. [PMID: 7002200 DOI: 10.1111/j.1365-2141.1980.tb07151.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
The laboratory diagnosis of autoimmune thrombocytopenia has only recently become more satisfactory. In this study a fluorescein-labelled antiglobulin technique was used to investigate the immunochemical properties of the platelet antibody detected in a pregnant woman with severe thrombocytopenia. The antibody was autoimmune and appeared to have specificity for platelet antigens. It had both IgG and IgM components and did not fix complement. Steroids had a beneficial effect indicated by a return to normal of the platelet count, a falling antibody titre and the disappearance of detectable antibody on the patient's own platelets. Studies on the baby showed that the antibody had not crossed the placenta in detectable amounts.
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Mueller-Eckhardt C, Mayr W, Lechner K, Mueller-Eckhardt G, Niessner H, Pralle H. HLA antigens in immunologic thrombocytopenic purpura (ITP). SCANDINAVIAN JOURNAL OF HAEMATOLOGY 1979; 23:348-52. [PMID: 575432 DOI: 10.1111/j.1600-0609.1979.tb02872.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
79 patients with definite ITP were investigated for HLA-A, -B, -C antigens. There was an increased frequencey of HLA-B5 in the entire groups (27.8% vs. 16.5% in controls and for HLA-B12 in male patients. However, after correction for the number of antigens tested, the difference of antigen frequencies became insignificant.
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36
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Waldschmidt R, Mueller-Eckhardt C. Stimulation of lymphocytes by platelet-antibody-complexes and their role in the pathogenesis of idiopathic thrombocytopenia. BLUT 1979; 39:53-60. [PMID: 572717 DOI: 10.1007/bf01008075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The effect of washed human platelets, platelet lysates, and platelet antibody complexes on 14C-thymidine incorporation by human lymphocytes was studied. For sensitization of platelets, HLA-specific alloantibodies as well as platelet autoantibodies were used. Lymphocytes for in vitro cultures were collected from unsensitized individuals, healthy women with proven fetomaternal immunization against HLA antigens and patients with idiopathic thrombocytopenic purpura (ITP). Unsensitized platelets have a dose-dependent inhibitory effect on the in vitro proliferation of normal lymphocytes induced by mitogens (PHA, ConA, PWM). Platelet antibody complexes (allo- and autoantibodies; allogenic and autologous lymphocyte-platelet combinations) did not stimulate 14C-thymidine incorporation. Lymphocytes from ITP patients showed a significantly reduced stimulatory response toward PHA compared to normal persons. These findings are discussed in the light of our present knowledge regarding the role of cellular immune reactions in the pathogenesis of ITP.
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