Schwartz K A
Department of Medicine, Michigan State University, East Lansing 48824.
Am J Hematol. 1988 Oct;29(2):106-14. doi: 10.1002/ajh.2830290208.
The driving force behind development of in vitro methods for platelet antibodies is identification of plasma factors causing platelet destruction. Early methods relied on measurement of platelet activation. Current methods are more specific and use a purified antibody against immunoglobulin or complement, which is usually labeled with 125I or tagged with an enzyme or fluorescein. Comparisons of quantitation of platelet-associated IgG show wide variability between different methods. The disparate results can be related both to differences in binding of secondary antibodies to immunoglobulin in solution compared to immunoglobulins attached to platelets and to the improper assumption that the binding ratio between the secondary detecting and primary antiplatelet antibody is one. Most assays can 1) identify neonatal isoimmune thrombocytopenia and posttransfusion purpura, 2) help to differentiate between immune and nonimmune thrombocytopenias, 3) help to sort out the offending drug when drug-induced thrombocytopenia is suspected, and 4) identify platelet alloantibodies and potential platelet donors via a cross match assay for refractory patients. However, the advantages of quantitative assays over qualitative methods with respect to predictions of patients clinical course and response to different treatments remain to be investigated.
开发血小板抗体体外检测方法的背后驱动力是识别导致血小板破坏的血浆因子。早期方法依赖于血小板活化的测量。目前的方法更具特异性，使用针对免疫球蛋白或补体的纯化抗体，该抗体通常用125I标记或用酶或荧光素标记。血小板相关IgG定量的比较显示不同方法之间存在很大差异。这些不同的结果既可能与二抗与溶液中的免疫球蛋白结合与附着在血小板上的免疫球蛋白的差异有关，也与二抗检测抗体与一抗血小板抗体之间的结合比为1这一错误假设有关。大多数检测方法可以：1）识别新生儿同种免疫性血小板减少症和输血后紫癜，2）有助于区分免疫性和非免疫性血小板减少症，3）当怀疑药物性血小板减少症时有助于找出致病药物，4）通过对难治性患者的交叉配型试验识别血小板同种抗体和潜在的血小板供体。然而，定量检测相对于定性方法在预测患者临床病程和对不同治疗的反应方面的优势仍有待研究。
