Latent and Overt Polyautoimmunity in Children and Adolescents With Immune Thrombocytopenia

Abstract

Autoantibodies are biomarkers for autoimmune disease diagnosis, monitoring, and prediction. Therefore, this study established the frequency of latent and overt polyautoimmunity in children and adolescents with >6 months of diagnosis of immune thrombocytopenia (ITP). Forty-seven patients with chronic or persistent disease had non–organ-specific and organ-specific autoantibodies assessed. Frequency of latent polyautoimmunity was 36.2%, and, of overt polyautoimmunity, it was 4.3%. Of ITP patients with latent polyautoimmunity, 52.9% were positive for antinuclear antibody (ANA), 47.1% for autoantibodies other than ANA, and 64.7% for multiple autoantibodies. In addition, patients with latent polyautoimmunity and those positive for ANA were significantly older at disease onset. Both ITP patients positive and negative for autoantibodies reported family members with autoimmune diseases. The autoantibodies observed were as follows: ANA, anti-dsDNA, anti-SSA/Ro, IgM aCL, anti-GAD, anti-IA2, anti-IAA, anti-TG, anti-TPO, anti-LKM1, and SMA. Of ITP patients with overt polyautoimmunity, 1 was diagnosed with type 1 diabetes mellitus and the other with thyroiditis. In conclusion, children and adolescents with ITP present high frequency of latent and overt polyautoimmunity even for autoantibodies other than ANA. Therefore, ANA and other non–organ-specific and organ-specific autoantibodies should be considered for assessment during ITP patients’ follow-up.

Multiple autoimmune syndrome complicating the management of diabetic retinopathy

“…Only one patient in this group had T1D as part of the polyautoimmunity spectrum. 21 Rashid et al described ITP in a case of diabetic nephropathy, which only manifested after renal transplantation. 22 Tshcudin et al reported two patients with T1D associated with ITP, neither of these two cases presented with ophthalmic manifestations.…”

Is There a Need to Look for Antithyroid Antibodies in Children With Immune Thrombocytopenia?

“…One of these 2 patients was described as having overt hypothyroidism. 4 The patient reported by Kamioka et al 1…”

“…I read with interest the paper on polyautoimmunity in childhood immune thrombocytopenia (ITP) by Kamioka et al 1 but I would like to challenge the suggestion of looking for antithyroid antibodies in children with otherwise uncomplicated ITP outside a research setting. Our experience and data from the published literature do not support a prognostic value of antithyroid antibodies in the management of ITP.…”

“…To the Editor: Factor X (FX) is a coagulation factor that is activated by FVIIIa-FIXa or FVII-tissue factor complex. 1…”

Adapted guideline for the diagnosis and treatment of primary immune thrombocytopenia for Chinese children (2021)

“… 20 , 21 Five retrospective case series studies include 120 children with chronic ITP in total, among whom 11 children were finally diagnosed with systemic lupus erythematosus (SLE) by means of autoimmune panel, and two were diagnosed with immune deficiency. 22 , 23 , 24 , 25 , 26 Among 309 children with previous diagnosis of chronic thrombocytopenia, 141 children were diagnosed with hereditary thrombocytopenia by means of genetic test. 20 , 21 , 23 , 24 , 25…”