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Differentiation of autoimmune thrombocytopenia from thrombocytopenia associated with immune complex disease: systemic lupus erythematosus, hepatitis‐cirrhosis, and HIV‐1 infection by platelet and serum immunological measurements
Author(s) -
Samuel Hala,
Nardi Michael,
Karpatkin Margaret,
Hart David,
Belmont Michael,
Karpatkin Simon
Publication year - 1999
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1046/j.1365-2141.1999.01469.x
Subject(s) - medicine , platelet , immunology , antibody , autoimmune hepatitis , immune complex , cirrhosis , immune system , autoimmune disease , gastroenterology , hepatitis
A method and approach are described to differentiate classic autoimmune thrombocytopenia (ATP) from immune complex‐associated thrombocytopenia in systemic lupus (SLE), hepatitis/chronic liver disease (LIV‐ITP) and HIV‐1 related thrombocytopenia (HIV‐1‐ITP). The platelet immunologic profile of IgG, C3C4 and IgM was measured with a solid‐phase ELISA, employing 125 I‐staphylococcal protein A to detect indicator antibody binding. Polyethylene glycol was employed to precipitate immune complexes (PEG‐IC). Platelet‐associated IgG (PAIgG) was 2.8‐, 5.6‐ and 5.8‐fold higher in SLE, LIV‐ITP and HIV‐1‐ITP patients respectively compared to ATP patients; platelet C3C4 was 3.2‐, 4.8‐ and 4.5‐fold higher respectively; platelet IgM was 2.2‐, 3.7‐ and 3.8‐fold higher respectively; serum PEG‐IC levels were 4.2‐, 4.8‐ and 2.1‐fold higher respectively. With all parameters measured, there was no overlap between the 75th percentile for ATP patients and the 25th percentile for all three cohorts. The likelihood of having a platelet C3C4 level higher than the highest ATP level was 69% for SLE, 90% for LIV‐ITP and 94% for HIV‐1‐ITP respectively; with PEG‐IC measurements the likelihood was 83%, 100% and 100% respectively. Serum IgG, C3, C4, IgM and PEG‐IC were examined for a possible relationship with platelet measurements. Except for a positive correlation between serum and platelet IgM in ATP, r = 0.5, P < 0.04, there was no positive correlation with any of the parameters measured. An inverse correlation was noted between PEG‐IC level and platelet C3C4 in SLE, r = 0.7, P < 0.04. Thus platelet immunologic profile and serum PEG‐IC level measurements differentiated classic ATP from immune complex‐associated thrombocytopenias (SLE, LIV‐ITP, HIV‐1‐ITP). Except for IgM measurements in ATP, platelet measurements could not be attributed to their respective serum concentration.