Quantification of platelet-bound alloantibodies by radioimmunoassay: a study on some variables

Relative importance of total versus external platelet-associated IgG

We present measurements of total platelet-associated immunoglobulin G following platelet lysis (PAIgG tot) and surface-restricted IgG (PAIgG ext) on intact, gel-filtered platelets from 36 normal human donors and 9 patients with human immunodeficiency virus (HIV) infection (CDC stages IIb-IV). For this purpose, an indirect micro ELI-SA technique was developed involving competition between PAIgG and solid-phase absorbed IgG for fixation of conjugated anti-human IgG antibody. In normal donors, the mean values of PAIgG tot was 8.3 +/- 7.4 (mean +/- 2 SD) and of PAIgG ext 4.2 +/- 4.4 fg/platelet. In HIV-infected subjects, PAIgG tot was 37.2 +/- 62.8 and PAIgG ext 17.1 +/- 23 fg/platelet. In healthy subjects the comparison of individual levels of PAIgG tot and PAIgG ext revealed a significant correlation (r:0.763; p: 0.003). These results are compared to those which have been reported in the literature. In addition, the major immunopathological mechanisms considered responsible for immune-mediated idiopathic thrombocytopenic purpura are discussed.

Platelet-associated IgG in thrombocytopenia: a comparison of two techniques

The results obtained in the analysis of 130 thrombocytopenic patients with a radioimmunoassay (RIA) for platelet-associated IgG (PA-IgG) and the platelet suspension immunofluorescence test (PIFT) were compared. The RIA was positive in 33 of 41 (82.9%) patients with idiopathic thrombocytopenia (ITP) and in 51 of 79 (64.4%) patients with secondary thrombocytopenia (STP). The PIFT was positive in 37 of the 41 (90.2%) ITP patients and in 57 of the 79 (72.2%) STP patients. Sensitivity and specificity for the diagnosis of ITP of both tests were comparable: 82.9 and 40.9% for the PA-IgG(RIA) and 90.2 and 36.7% for the PIFT. A significant positive correlation was observed between the mean amount of PA-IgG measured and the height of PIFT scores with anti-IgG. Of 38 discrepancies between PA-IgG(RIA) and PIFT with anti-IgG, 15 were due to borderline results, 17 were associated with abnormal platelet-size distribution and 20 were associated with occurrence of IgM antibodies. These results suggest influences of platelet fragments and/or aggregates on accurate measurement of PA-IgG. Both fragments and aggregates escape from accurate platelet counting, while their contribution to the total IgG content remains. Therefore, a falsely elevated PA-IgG (RIA) may be measured.

Clinical significance of positive platelet immunofluorescence test in thrombocytopenia

The sensitivity and specificity of the platelet immunofluorescence test for the diagnosis of idiopathic thrombocytopenia (ITP) was studied in a series of 255 patients. Patients' platelets were tested directly. Diethyl-ether eluates of these platelets and patients' sera were tested indirectly with normal donor platelets. When all three tests were considered, positive results were obtained for 92.0% of the ITP patients with a platelet count of less than 150 X 10(9)/l and for 98.4% of the patients with a count of less than 100 X 10(9)/l. However, for many patients rather weak test results were obtained, with a score of 1/2-1 in 59.8% of the patients. Most patients (94.1%) with a positive direct test had a positive indirect test on the eluate. Thus, platelet-bound antibodies but not platelet-bound immune complexes were present in most, if not all, patients. Positive immunofluorescence tests were obtained for many patients with a diagnosis other than ITP. This resulted in a low specificity of the test for the diagnosis of ITP, evidently because autoimmune thrombocytopenia occurred together with many other diseases and also because antibodies against platelet cryptantigens (expressed by the action of EDTA or by platelet fixation) were present in many patients.