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Chapter 128 : Autoimmune Thrombocytopenia

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Abstract:

A chronic form of autoimmune thrombocytopenia exists and is the clinical course most often seen in adults. With characterization of the immunopathological features of autoimmune thrombocytopenia, a variety of methods have been developed to measure the antiplatelet autoantibodies that mediate the immune destruction of platelets in this disorder. The risk of chronicity increases with increased age of the child; otherwise, there are no prognostic features, either clinical or laboratory, that will predict whether a child with acute immune thrombocytopenia will recover spontaneously. The pathogenic factor present in the plasma reacted with normal and autologous platelets and could be isolated and removed from the gamma fraction of plasma by adsorption with platelets. Patients with chronic autoimmune thrombocytopenia typically present with petechiae and mucosa bleeding. Symptoms may be present for months, or some patients may experience more acute manifestations. Quantitative measurements based on antiglobulin consumption give falsely high values for platelet-associated immunoglobulin because antiglobulin binds differently to membrane-bound immunoglobulin G (IgG) than to the IgG in the solution used to calibrate the standard curve.

Citation: Kickler T. 2006. Autoimmune Thrombocytopenia, p 1132-1135. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch128

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FIGURE 1

Platelet autoantibody assays. In the solid-phase assay, a microtiter well or plastic bead is coated with a monoclonal antibody (MoAB) to a specific platelet glycoprotein, such as GPIIb-IIIa or Ib-IX. Platelets from a patient with idiopathic thrombocytopenia purpura are washed, solubilized with detergent, and added to the coated surface to allow capture by platelet glycoprotein complex and bound autoantibody (AutoAb). The autoantibody is measured using labeled antihuman IgG. The MAIPA is similar, except that the murine monoclonal antiplatelet glycoprotein antibody is added to the autoantibody-sensitized platelets and the immune complex composed of platelet glycoprotein, mouse monoclonal antibody, and human immunoglobulin is captured with an anti-mouse antibody.

Citation: Kickler T. 2006. Autoimmune Thrombocytopenia, p 1132-1135. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch128
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References

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