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ITP in children is an acquired hemorrhagic disorder due to excessive destruction of circulating platelets. Most children have acute self-limited illness, however, 10-20% develop a chronic disease. A method previously described (Blood 50:137, 1977) was used to measure PAIgG in our childhood ITP cases. Serial PAIgG values were obtained during the clinical course in some cases. Platelets from controls and ITP subjects were re-suspended in 0.05 M citrate buffer and gel filtered through a sepharose 2B column. A known quantity of washed platelets was assayed for PAIgG using the Fab anti-Fab immunoassay. Results were expressed as nanograms IgG per 109 platelets (ngIgG/109 plts). Mean PAIgG value in 7 acute ITP children was 12,552±8874 ngIgG/109 plts; 13 chronic ITP children had PAIgG value of 3956±1090. Both values were significantly greater than age-matched normals and thrombocytopenic controls of 1446±580 (p<.001). The chronic ITP values were significantly lower than acute ITP (p<.003). Elevated values in acute ITP became normal with clinical recovery. Three children with chronic ITP post splenectomy had values return to normal. One child with chronic ITP refractory to splenectomy responded to cyclophosphamide with a fall in PAIgG values. We conclude the following: 1) the measurement of PAIgG is useful in the diagnosis and follow-up of childhood ITP cases, and 2) PAIgG values may assist in differentiating acute and chronic disease in children.

626 THE MEASUREMENT OF PLATELET-ASSOCIATED IMMUNOGLOBULIN G (PAIgG) IN EVALUATING CHILDHOOD IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP)