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Prevalence and clinical significance of elevated antiphospholipid
antibodies in patients with idiopathic thrombocytopenic purpura
R Stasi, E Stipa, M Masi, F Oliva, A Sciarra, A Perrotti, M Olivieri, G Zaccari, GM Gandolfo and M Galli
Department of Hematology, University of Rome Tor Vergata, S. Eugenio
Hospital, Italy.
Antibodies against phospholipid antigens (APA) have been demonstrated in
idiopathic thrombocytopenic purpura (ITP), but their clinical and
pathogenetic significance has remained elusive. In this study we analyzed
the prevalence and clinical features of ITP patients with elevated APA. In
addition, we prospectively evaluated APA levels after treatment with
corticosteroids and compared them with platelet- associated immunoglobulin
(PAIgG) titers. We studied 149 patients with newly diagnosed ITP. Of these,
78 had a platelet count less than 50 x 10(9)/L and received an initial
treatment with oral prednisone (PDN). In 71 asymptomatic cases with
platelet counts between 50 x 10(9)/L and 120 x 10(9)/L, no therapy was
scheduled. However, in five of them, the platelet count fell below 50 x
10(9)/L after more than 12 months; these patients were treated with PDN.
Tests for APA included the measurement of anticardiolipin antibodies (ACA)
with a solid-phase immunoassay and the detection of the lupus-like
anticoagulant (LA) activity with coagulation tests that included
kaolin-clotting time, dilute Russel's Viper venom time, activated partial
thromboplastin time (aPTT), and dilute aPTT. Controls consisted of 174
apparently healthy subjects. Either LA or elevated ACA was seen in 69
patients (46.3%) at diagnosis. LA and ACA were both elevated in 24 cases
(16.1% of the overall patient population and 34.8% of patients with high
APA concentrations). No correlation was found between LA ratio values and
ACA-IgG or -IgM titers, or between ACA-IgG and ACA-IgM levels. The presence
of these antibodies was not associated with sex, age, platelet count, or
the severity of hemorrhages. PAIgG was detected in 106 of 127 cases (83%).
Again, no relationship was observed with clinical parameters or with APA
levels. However, all cases with elevated APA also had increased PAIgG. With
regard to the clinical course, we were not able to detect any significant
difference between patients with normal and elevated APA. An initial
complete response to prednisone treatment was observed in 43 of 83 cases
(51.8%), with 13 (15.7%) achieving a prolonged complete remission. APA
levels were not significantly modified after PDN therapy and on relapse. We
conclude that APA positivity is a common finding in patients with ITP and
does not select a category with different clinical features. APA levels are
not influenced by immunosuppressive therapy with steroids and are not
related to the activity of the disease. Therefore, we do not support a role
for APA in the pathogenesis of ITP.
Volume 84,
Issue 12,
pp. 4203-4208,
12/15/1994
Copyright © 1994 by The American Society of Hematology
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