The Role of Antiplatelet Autoantibody Assays in the Diagnosis of Immune Thrombocytopenic Purpura

Immune thrombocytopenic purpura (ITP) is a disorder almost always manifested by antibody-induced thrombocytopenia. In 1987, two clinically useful antigen-specific assays were reported, the immunobead assay and the monoclonal antibody-specific immobilization of platelet antigens (MAIPA) assay. These two assays and their variations give similar results and can measure both platelet-associated and plasma antibodies. Three prospective studies have reported assay results with sensitivities ranging from 49% to 66% and specificities ranging from 78% to 93%. Most antibodies react with either platelet glycoprotein (GP) IIb/IIIa or GPIb/IX. Recent evidence suggests that antiplatelet antibody assays may also be useful in predicting disease prognosis. Rare ITP patients have bleeding with normal or near-normal platelet counts, a prolonged bleeding time, and aggregation abnormalities due to autoantibodies that affect platelet function. Incubation of patient plasma, IgG or eluate with normal platelet-rich plasma reproduces the patient's aggregation abnormalities.