期刊
BLOOD
卷 117, 期 21, 页码 5723-5732出版社
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2010-11-321398
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资金
- Sysmex XE2100 Corporation
- Dana Hammond Stubgen
- Children's Cancer and Blood Foundation
- National Institutes of Health [U01 HL072186]
- Amgen
- GlaxoSmithKline
- Eisai
- Shionogi
- Ligand
- Cangene
- Sysmex
This study investigated the immature platelet fraction (IPF) in assessing treatment effects in immune thrombocytopenia (ITP). IPF was measured on the Sys-mex XE2100 autoanalyzer. The mean absolute-IPF (A-IPF) was lower for ITP patients than for healthy controls (3.2 vs 7.8 x 10(9)/L, P<.01), whereas IPF percentage was greater (29.2% vs 3.2%, P<.01). All 5 patients with a platelet response to Eltrombopag, a thrombopoietic agent, but none responding to an anti-Fc gamma RIII antibody, had corresponding A-IPF responses. Seven of 7 patients responding to RhoD immuneglobulin (anti-D) and 6 of 8 responding to intravenous immunoglobulin (IVIG) did not have corresponding increases in A-IPF, but 2 with IVIG and 1 with IVIG anti-D did. This supports inhibition of platelet destruction as the primary mechanism of intravenous anti-D and IVIG, although IVIG may also enhance thrombopoiesis. Plasma glycocalicin, released during platelet destruction, normalized as glycocalicin index, was higher in ITP patients than controls (31.36 vs 1.75, P=.001). There was an inverse correlation between glycocalicin index and A-IPF in ITP patients (r(2) = -0.578, P=.015), demonstrating the relationship between platelet production and destruction. Nonresponders to thrombopoietic agents had increased megakaryocytes but not increased A-IPF, suggesting that antibodies blocked platelet release. In conclusion, A-IPF measures real-time thrombopoiesis, providing insight into mechanisms of treatment effect. (Blood. 2011; 117(21): 5723-5732)
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