Nagasawa T, Hasegawa Y, Komeno T, Itoh T, Ninomiya H, Abe T
Division of Haematology, University of Tsukuba, Japan.
Eur J Haematol. 1995 May;54(5):314-20. doi: 10.1111/j.1600-0609.1995.tb00692.x.
We have simultaneously measured platelet-associated IgG (PAIgG) and megakaryocyte-associated IgG (MAIgG) in 30 untreated patients with chronic idiopathic thrombocytopenic purpura (CITP). Megakaryocytes were purified from bone marrow by 35% Percoll gradient centrifugation, followed by negative immunopanning using magnetic immunobeads. The normal range of MAIgG in 30 healthy donors was 15.5 +/- 10.0 ng/10(5) megakaryocytes, whereas MAIgG in the 30 CITP patients was 140 +/- 59.3 ng/10(5) megakaryocytes, although the values were widely distributed. From the PAIgG and MAIgG data, CITP patients were classified into three types; type I (PAIgG < 200 ng/10(7) platelets and MAIgG < 150 ng/10(5) megakaryocytes), type II (PAIgG > 200 ng and MAIgG > 150 ng), and type III (PAIgG < 200 ng and MAIgG > 150 ng). Patients with types I and III had good clinical courses, but, in contrast, patients with type II responded poorly to steroid therapy followed by splenectomy or became refractory to treatment. In splenectomized patients, MAIgG of responder was promptly decreased to normal range and, in contrast, that of non-responder was persistently elevated. These results indicate that anti-platelet autoantibodies are able to bind with megakaryocytes in the bone marrow as well as with platelets in the peripheral blood, and the results also suggest that megakaryopoiesis in CITP is heterogeneous. Simultaneous measurement of PAIgG and MAIgG may predict the clinical outcome of CIPT.
