Platelet production, clearance and distribution in patients with idiopathic thrombocytopenic purpura

Platelet destruction mechanism was thought to play a primary role in autoimmune thrombocytopenia (ITP). There is, however, some evidence that anti-platelet antibodies in ITP impair megakaryocytopoiesis. Using autologous In-111 platelets, we tried to elucidate this point. We measured platelet survival, platelet turnover, platelet sequestration sites, and platelet production (turnover) to the clearance (sum of liver and spleen platelet uptake) ratio in 8 normal subjects and 12 patients with ITP whose platelet counts ranged from 9 x 10(9) to 40 x 10(9)/L. The sum of platelet uptake in the liver and spleen showed a significant inverse correlation with platelet survival. Platelet survival, platelet production to clearance ratio correlated significantly with the platelet count. No significant correlation was found between platelet turnover and platelet counts. The distribution of platelet turnover showed considerable individual variation; 8 of 12 patients showed platelet turnovers which were lower than the normal value, but the others were within the normal range. We concluded that although the platelet destruction mechanism in the reticuloendothelial system shows a primary role in thrombocytopenia, the impaired rate of effective thrombopoiesis may also contribute to the severity of ITP.