Thrombopoiesis in itp and hiv-itp and in response to intravenous gammaglobulin (ivig)treatment Academic Article uri icon

Overview

MeSH Major

  • Asthma
  • Bronchoalveolar Lavage Fluid
  • Glycoproteins

abstract

  • Currently, diagnosis of immune thrombocytopenic purpura (ITP)is based on low platelet count and exclusion of clinical conditions rather than demonstration of a laboratory finding ie +platelet antibodies. This study applied the thiazole orange assay of reticulated platelets (RP) to classsical ITP and thrombocytopenia associated with HIV infection (HIV-ITP). Data of 96 ITP patients, (1 sample/patient), gave low PC with both high & low % reticulated platelets (RP). -15% had % RP below(L)normal range: 0.7 ±0.7 %RP associated with a mean PC of 141±220xlO"/L; 33% were normal range (N), 1.2±1.2 %RP with 80±100xl09/L PC & 53% were higher at 3.3±4.3 %RP with PC of 65+94x10'/L.3 patients tested within 24h of IVIG had circulating PC with lower RP than expected: PC/L increased 15.75, 6.8 or 4.6X, corresponding RPxlO'/L (RP/L) increased to 4.5 & l .88X or decreased to 0.23X, suggesting dilution by an older platelet population. 4 patients measured within 10 days of IVIG gave: Before IVIG: PC=9±11,5; %RP=9±4.6; RP/L=0.67±0.58. After IVIG: PC=115±9I ; %RP=1.8±1.3; RP/L=2.8+2.6. TPO levels of 21 ITP patients were 235± 124 (range 100-654) pg/mL compared to the normal level of 123 (range 21 -407 ) pg/mL, but there was no correlation with PC, %RP or RP/L. PC<30 PC<30 PC<30 PC>30 PC>30 PC>30 %RP RP/L L&N %RP "RP RP/L L&N %RP ITP. n=93 6.1±4.4 0.7±0.7 9/38,24" 2.9+2.9 3.3±0.7 35/55,64" HIV-ITP, n=22 5.7±5.6 0.8±1.0 4/11,36" 4.0±3 1.911.6 6/11,54" In this study (1 sample/patient) HIV-ITP patients had more profound thrombocytopenia (PC=31±20xlO'/L, n=23) than did ITP patients (82±120xlO'/L, n=96) with p<0.05 by anova and (-test. Some serial samples of HIV-ITP patients showed high %RP and low PC similar to ITP, suggesting destruction. Others showed the low %RP & low PC profile of impaired thrombopoiesis. Responses to IV gammaglobulins were like those of ITP patients. Overall ITP and HIV-ITP patients were heterogeneous in terms of their thrombopoiesis and remarkably similar in their heterogeneity. Preliminary studies show estimation of RP as a measure of thrombopoiesis may predict responses to treatments whose primary effect is interference with platelet destruction.

publication date

  • December 2000

Research

keywords

  • Academic Article

Additional Document Info

start page

  • 65b

volume

  • 96

number

  • 11 PART II