Clinical studies| Volume 108, ISSUE 7, P554-560, May 2000

Autoantibodies against platelet glycoproteins in critically ill patients with thrombocytopenia


      PURPOSE: The aim of the study was to investigate immunologic causes of thrombocytopenia in critically ill patients, especially causes that were related to platelet-associated IgG antibodies.
      SUBJECTS AND METHODS: All patients admitted to two intensive care units between May 1 and October 30, 1997, who developed thrombocytopenia (less than 100 × 109 platelets/L) were studied prospectively. We measured platelet-associated IgG with a radioimmunoassay using I125-labeled polyclonal antihuman IgG. Characterization of platelet-associated IgG was assessed with a monoclonal antibody immobilization of platelet antigen. Circulating immune complexes were also assayed.
      RESULTS: Of the 61 patients with thrombocytopenia, elevated platelet-associated IgG was found in 18 (30%). Associated antiplatelet autoantibodies (glycoprotein IIb/IIIa) were detected in 4 patients, circulating autoantibodies (glycoprotein Ib/IX) were detected in sera from 2 patients, and circulating immune complexes were detected in 3 patients. The nature of the platelet-associated IgG could not be determined in 10 patients. Elevated platelet-associated IgG was associated with sepsis and previous cardiopulmonary bypass. Thrombocytopenic patients with elevated platelet-associated IgG had a lower nadir platelet count (58 ± 27 × 109/L vs 74 ± 24 × 109/L, P = 0.03).
      CONCLUSION: Elevated platelet-associated IgG, some of which are platelet autoantibodies, is frequent in thrombocytopenic patients with sepsis or after cardiopulmonary bypass.
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