Platelet autoantibodies in immune thrombocytopenic purpura

In summary, the search for a useful clinical laboratory diagnostic assay for the antiplatelet antibodies has been long and difficult. Measurement of platelet associated IgG (PAIgG) has been disappointing as a way to detect autoantibodies. This is primarily due to the fact that platelets normally contain IgG in their alpha granules in an amount that varies with plasma IgG levels and age of the platelets. Furthermore, the amounts of platelet associated IgG is affected by the presence of circulating immune complexes, platelet activation, and drug dependent antibodies. The newer, platelet antigen capture techniques are promising, but further testing will be needed to confirm their value to the clinician. Methods that allow incubation of patient serum or plasma with intact platelets (MAIPA and immunobead) have greater sensitivity than techniques in which the patient antibody is tested against previously isolated platelet glycoproteins. These assays are currently available in a only a limited number of platelet immunology laboratories. Platelet autoantibodies are directed against a number of glycoprotein antigens on the platelet surface. Most studies have shown that anti GPIIb/IIIa antibodies are the most common, although antibodies against GPIb/IX and other targets are frequently detected. Many patients have multiple antiplatelet antibodies circulating simultaneously. The clinical significance of antibodies with different specificity is under investigation. The precise epitopes on GPIIIa that bind antiplatelet autoantibodies have been studied to a limited extent. Some investigators report that the vast majority of platelet antigens are conformation dependent, being destroyed by treatment with EDTA (separation of GPIIb and GPIIIa) or denaturation with detergents. Others report sequence specific peptide antigens. Further investigation promises to better define the targets for platelet autoantibodies; improved clinical management of patients with ITP is the long term goal of these studies.