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Prospective evaluation of the clinical usefulness of an antigen- specific
assay (MAIPA) in idiopathic thrombocytopenic purpura and other immune
thrombocytopenias
TA Brighton, S Evans, PA Castaldi, CN Chesterman and BH Chong
Department of Hematology, Prince of Wales Hospital, University of New South
Wales, Randwick, Sydney, Australia.
The diagnosis of idiopathic immune thrombocytopenia remains a clinical
diagnosis based on the exclusion of other causes of immune and nonimmune
thrombocytopenia. Measurement of platelet-associated Ig (PAIg), while
sensitive, is nonspecific for the diagnosis of immune thrombocytopenia.
Published experience of antigen capture assays (including monoclonal
antibody immobilization of platelet antigens or MAIPA) suggest a high
sensitivity and specificity (70% to 80%) in selected groups of patients. In
a prospective evaluation of 158 patients with thrombocytopenia from all
causes, we report a sensitivity of 51% and specificity of 80% for direct
MAIPA assays. MAIPA was considerably better in discriminating immune from
nonimmune thrombocytopenia than two assays of PAIgG. Antiplatelet
antibodies detected by MAIPA were more frequently directed against the
glycoprotein (GP) IIb/IIIa than the GP Ib/IX complex. Our experience
suggests that MAIPA assays are useful in the laboratory assessment of
thrombocytopenia, should be performed before therapy, and that some
patients with 'nonimmune' thrombocytopenia may have genuine antiplatelet
antibodies.
Volume 88,
Issue 1,
pp. 194-201,
07/01/1996
Copyright © 1996 by The American Society of Hematology
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