Value of B-cell activating factor expression in the diagnosis and prognosis of children with idiopathic thrombocyto-penic purpura / 临床儿科杂志

Objective To study the value of B-cell activating factor (BAFF) expression levels in the diagnosis and prog-nosis of children with idiopathic thrombocytopenic purpura. Methods Children with idiopathic thrombocytopenic purpura (ITP) admitted to our hospital from September 2011 to September 2013 were enrolled in observation group, and healthy check-up chil-dren during the same period were enrolled as controls. The serum levels of B-cell activating factor, platelet antibodies (PAIgG, PAIgM, PAIgA) and platelet count were detected, and curative effect in children with ITP was observed. Results The BAFF, PAIgG, PAIgM and PAIgA levels were higher and platelet count were less in both acute and chronic ITP children than those in normal controls. The difference was signiifcant (P<0.05). The results of linear regression analysis indicated that BAFF levels were positively correlated with PAIgG, PAIgM and PAIgA levels (β=1.87~2.25, P<0.05), and were negatively correlated with platelet count (β=-2.42, P<0.05). Meanwhile, BAFF levels were negatively correlated with curative effect in ITP children (β=-1.88, P<0.05). When the value of BAFF was 1.35, the sensitivity for predicting effective treatment was 0.84 and the speciifcity was 0.75. The area under the ROC curve was 0.85 (95%CI:0.73~0.98, P=0.000). Conclusions The serum BAFF expression was increased and closely related to the level of antiplatelet antibody, platelet count and treatment effect in ITP children, and therefore, was a good indicator for the diagnosis and prognosis of ITP.

The Clinical Implications of Antiplatelet Antibody / 임상검사와정도관리

BACKGROUND: Antiplatelet antibody test is the most important tool for the diagnosis of immune mediated thrombocytopenia. But antiplatelet antibody can occur in various diseases and the detection rates of antiplatelet antibody differ among investigators. In this study we investigated the prevalence of antiplatelet antibody in thrombocytopenic patients with various clinical conditions and analyzed the clinical significance of antiplatelet antibody in thrombocytopenia. METHODS: We tested 130 thrombocytopenic patients from 1999 January to 2000 October. The clinical diagnosis of the patients were 30 idiopathic thrombocytopenic purpura (ITP), 12 hematological diseases, 29 sepsis, 17 liver diseases, 11 pregnancy, 8 solid tumor, 2 malaria and 21 unclassified disorders. Antiplatelet antibody was detected by means of indirect immunofluorescence test. RESULTS: Antiplatelet antibody was detected in 6.2% of total patients (8/130) ; ITP 10% (3/30), malaria infection 50%(1/2), sepsis 3.5%(1/29), liver diseases 5.9%(1/17), solid tumors 12.5%(1/8), other unclassified disorders 4.8%(1/21). Antiplatelet antibody was negative in three drug induced thrombocytopenic patients. CONCLUSIONS: The positive rate of indirect immunofluorescent antiplatelet antibody was unexpectedly low in immune mediated thrombocytopenia. The positive results of non-immune mediated thrombocytopenia may be related to various conditions such as past platelet transfusions.

A Severe Thrombocytopenia Associated with Cyclosporine-Dependent Antiplatelet Antibody Against Platelet Glycoproteins Ib/IX and IIb/IIIa Complexes / 대한임상병리학회지

A 51 year-old woman underwent living related renal transplantation under cyclosporine A immunosuppression. After surgery, she did well initially, but the serum creatinine level subsequently rose to 3.6 mg/dL on postoperative day 95, she was admitted at Severance Hospital for further evaluation. On admission day 4, a renal biopsy was performed, and the microscopic findings revealed an interstitial mononuclear cell infiltrate, suggestive of severe allograft rejection. Because of persistently impaired renal function, the patient was began on twice weekly hemodialysis, and the progression of renal deterioration paralleled the onset of a thrombocytopenia. The platelet count dropped to 13x109/L despite daily platelet transfusion. On admission day 19, antiplatelet antibody against the glycoprotein Ib/IX (GP Ib/IX) and glycoprotein IIb/IIIa (GP IIb/IIIa) complex was detected in the presence of cyclosporine A (CsA) with modified antigen capture ELISA (MACE) assay, thereby implicating the drug. CsA was stopped immediately and immunosuppression drug was changed to FK506. After CsA was discontinued 7 day later, her platelet count returned to normal, up to 170x109/L without requirement of any platelet concentrates. This paper presents the first case of CsA induced thrombocytopenia in Korea which was confirmed by in vitro CsA dependent antiplatelet antibody detection test.

Expression and significance of platelet membrane glycoproteins and antiplatelet antibody in patients with anaphylactoid purpura / 中华皮肤科杂志

Objective To investigate the expression and significance of platelet membrane glyco- proteins and antiplatelet antibody in patients with anaphylactoid purpura.Methods Forty-five patients with anaphylactoid purpura were divided into three groups according to their clinical manifestations,15 in dermal purpura group,18 in mixed group and 12 in nephritis group.The expression of CD62P,CD63 and CD41 in these 45 patients was detected by flow cytometry.The level of antiplatetlet antibody was analysed by ELISA with monoclonal antibody as the probe.Results The percentage of CD62P,CD63 and the level of an- tiplatelet antibody in patients in acute phase were significantly higher than those in regressive phase and those in normal control.Neither of the expression of CD62P,CD63 and CD41,nor the level of antiplatetlet antibody in nephritis group was significantly different from that in the mixed group.Compared with dermal purpura group,the percentage of CD62P was significantly higher in the nephritis group and mixed group. There was no significant difference in CD41 expression among all groups.Conclusion Abnormal humoral immunity exists in anaphylactoid purpura.The activation of platelet could be closely related to the progress of anaphylactoid purpura.CD62P and CD63 could be considered as an index for monitoring of symptoms, determination of prognosis and predicting the outcome in anaphylactoid purpura.