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Hamostaseologie 2019; 39(03): 250-258
DOI: 10.1055/s-0039-1678739
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Diagnosing Immune Thrombocytopenia

Ulrich J. Sachs
1   Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
2   Center for Transfusion Medicine and Haemotherapy, University Hospital Giessen and Marburg, Marburg, Germany
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Publication History

11 October 2018

08 January 2019

Publication Date:
14 February 2019 (online)

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Abstract

Although the detection of a characteristic autoantibody can prove immune thrombocytopenia (ITP), this diagnosis is often based on the exclusion of other causes of thrombocytopenia. Direct glycoprotein (GP)-specific tests have the property required to demonstrate such a characteristic autoantibody. In contrast, platelet-associated immunoglobulin G or antibody detection in plasma or serum is an insufficient diagnostic test. Moreover, data for commercial capture assays are sparse and their use is currently not recommended. A significant drawback of direct GP-specific tests is their low sensitivity, and a negative test result has no relevance. It is therefore also useful to establish a diagnosis of (primarily) hyperdestructive thrombocytopenia. A full blood count together with the immature platelet fraction has an excellent positive predictive value for ITP. Plasma glycocalicin has no apparent diagnostic value in identifying ITP patients, and conflicting data for TPO preclude its use for diagnostic purposes.

Zusammenfassung

Obwohl der Nachweis charakteristischer Autoantikörper eine Immunthrombozytopenie (ITP) sichern kann, wird die Diagnose oft auf der Basis des Ausschlusses anderer Ursachen einer Thrombozytopenie gestellt. Direkte glykoprotein (GP)-spezifische Tests besitzen die erforderliche Eigenschaft zum Nachweis charakteristischer ITP-Antikörper. Die Bestimmung von plättchen-assoziiertem IgG oder der Nachweis von Autoantikörpern aus Serum oder Plasma ist hingegen unzureichend. Zudem liegen nur spärliche Daten für die Verwendung kommerzieller Capture-Systeme vor, ihre Verwendung kann gegenwärtig nicht empfohlen werden. Ein relevanter Nachteil der direkten GP-spezifischen Tests ist ihre niedrige Sensitivität, ein negatives Testergebnis hat daher keine diagnostische Relevanz. Es ist daher auch sinnvoll, frühzeitig eine (primär) hyperdestruktive Thrombozytopenie zu sichern. Ein Blutbild zusammen mit der immature platelet fraction hat einen sehr guten positiven prädiktiven Wert für die ITP. Die Studienergebnisse für Plasma-Glycocalicin und Thrombopoeitin sind unzureichend, ihre Verwendung als diagnostischer Marker kann momentan nicht empfohlen werden.

Keywords

platelet - diagnosis - autoantibodies
 

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