Platelet‐Associated IgM Levels in Thrombocytopenia<sup>1</sup>

Pawha, Jasjit; Giuliani, Dennis; Morse, Bernard S.

doi:10.1111/j.1423-0410.1983.tb01893.x

Cited by 14 publications

(3 citation statements)

References 17 publications

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“…Varticovski et al [15] revealed antiplatelet activity of monoclonal IgM in a WM case. Two groups reported patients with WM-associated immune thrombocytopenia who showed elevated PA-IgM levels in contrast to normal PA-IgG levels [13,16]. In contrast, our case developed thrombocytopenia with increased PA-IgG in the course of WM.…”

Section: Discussioncontrasting

confidence: 81%

“…A few reports have referred to the mechanism of immune thrombocytopenia associated with WM, and both platelet-associated IgM (PA-IgM) and IgG (PA-IgG) have been shown to be a possible etiology [13,[15][16][17][18]. In this report, we show a case of immune thrombocytopenia in WM with IgM and IgG paraproteins, which improved after chemotherapy against WM.…”

Section: Introductionmentioning

confidence: 78%

“…Increased PA-IgM has been detected in some patients with immune thrombocytopenia related to WM [13,16,17]. Varticovski et al [15] revealed antiplatelet activity of monoclonal IgM in a WM case.…”

Section: Discussionmentioning

confidence: 98%

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IgG-associated immune thrombocytopenia in Waldenström macroglobulinemia

et al. 2010

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Waldenström macroglobulinemia (WM) is characterized by serum IgM monoclonal gammopathy, and only occasionally complicated by immune thrombocytopenia. Rarely, coexistence of non-IgM gammopathy in WM has been reported. Herein, we describe an 81-year-old case of WM with rapidly progressive immune thrombocytopenia accompanied by concurrent IgG gammopathy and elevation of platelet-associated IgG (PA-IgG). Immunostaining of the bone marrow specimen displayed not only IgM positive but also IgG positive plasmacytoid cells. Although dexamethasone therapy had no effect on thrombocytopenia, a modified RCD regimen (rituximab 375 mg/m(2) i.v. day 1, cyclophosphamide 375 mg/m(2) i.v. day 2 and dexamethasone 12 mg/body orally days 1-7) successfully normalized PA-IgG as well as IgG and IgM paraproteinemia and significantly increased platelet count. The current case suggests that the IgG gammopathy associated with WM is likely to be an etiology of immune thrombocytopenia and that tumor reduction, rather than immunosuppression, leads to an improvement of concurrent thrombocytopenia.

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Section: Discussioncontrasting

confidence: 81%

Section: Introductionmentioning

confidence: 78%

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IgG-associated immune thrombocytopenia in Waldenström macroglobulinemia

et al. 2010

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Use of the indirect platelet radioactive antiglobulin test with anti‐IgG and anti‐C3 in immune and nonimmune thrombocytopenias

1985

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Indirect platelet radioactive antiglobulin tests using anti-IgG and anti-C3 were performed in 483 individuals. The subjects' diagnoses and clinical states were correlated with sensitizing protein ( IgG and/or C3). Sensitivity of the technique was increased by increasing the serum to cell ratio and there was good Correlation between direct and indirect antiglobulin tests in 56 patients. Seven percent of normal healthy nonthrombocytopenic untransfused males and 88 % of patients in whom autoimmune thrornbocytopenia was clinically suspected showed a positive test result. In the indirect antiglobulin test, mean f SD fg anti-C3d/platelet was 1.75 f 0.28 (N = 58) with serum from normal subjects, 3.91 f 1.86 (N = 123) with serum from patients with idiopathic thrombocytopenic purpura and systemic lupus erythematosus, and 2.78 f 0.91 (N = 52) with serum from patients with lymphoproliferative disease.The differences were significant with P < 0.001. Levels of bound anti-IgG were in general accord with those of other reports; there was no significant relationship with serum immunoglobulin levels. When the indirect antiglobulin tests were positive for both IgG and C3, there was a significant correlation between IgG and C3 bound to normal platelets (r = 0.671; P < 0.01). Although sera from 39% of patients whose thrombocytopenia was not initially suspected to be on an autoimmune basis gave a positive test result, indirect platelet radioactive antiglobulin tests using anti-IgG and anti-C3 may be convenient tools in the evaluation and follow-up of immune thrombocytopenias.

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Platelet‐associated immunoglobulins IgG, IgM, IgA and complement C3 in immune and nonimmune thrombocytopenic disorders

Panzer

Szamait²,

Bödeker

et al. 1986

American J Hematol

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A two-stage radioactive antiglobulin test--using unlabelled antisera specific for IgG, IgA, IgM and C3 followed by binding of 125I-staphylococcal protein A--was applied to determine platelet-associated immunoglobulins (PAIg) and complement (PAC3) in thrombocytopenias of various etiologies. One hundred and one patients with immune thrombocytopenia (chronic autoimmune, 48; acute autoimmune, 37; Evans syndrome, nine; connective tissue diseases, seven) and 20 patients with presumed nonimmune thrombocytopenia (bone marrow aplasia or malignancy, six; septicemia, five; hypersplenism, five; cirrhosis of liver, three; others, one) were studied. Increased levels of PAIg/C3 were found in 76% of patients with immune thrombocytopenia. PAIgG was raised in 66%, PAIgM in 57%, PAIgA in 44%, and PAC3 in 29%. Isolated elevation of PAIgG and of PAIgM was found in four and three cases, respectively; PAIgA and PAC3 were elevated in one case each. PAIgG was associated with PAIgM in 56%, with PAIgA in 34%, and with PAC3 in 27%. Both patients with Evans' syndrome and patients with connective tissue diseases had significantly higher PAIgM levels than the other patients with immune thrombocytopenia. In patients with nonimmune thrombocytopenia, increased rates of PAIg/C3 were also encountered. Positive test results were found in 88% (PAIgG 88%, PAIgM 47%, PAIgA 35%, and PAC3 24%). In immune-mediated thrombocytopenia, we observed a significant inverse correlation between platelet counts and PAIgG, PAIgA, and PAC3, but not with PAIgM. In contrast, no such correlation was found in patients with nonimmune thrombocytopenia. Our data indicate that the evaluation of neither parameter alone nor the combination of PAIg/C3 will discriminate between immune and nonimmune thrombocytopenia. Preferential coating with certain immunoglobulins, however, may be present in some subgroups of immune thrombocytopenias.

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Platelet‐Associated IgM Levels in Thrombocytopenia¹

Cited by 14 publications

References 17 publications

IgG-associated immune thrombocytopenia in Waldenström macroglobulinemia

IgG-associated immune thrombocytopenia in Waldenström macroglobulinemia

Use of the indirect platelet radioactive antiglobulin test with anti‐IgG and anti‐C3 in immune and nonimmune thrombocytopenias

Platelet‐associated immunoglobulins IgG, IgM, IgA and complement C3 in immune and nonimmune thrombocytopenic disorders

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Platelet‐Associated IgM Levels in Thrombocytopenia1

Cited by 14 publications

References 17 publications

IgG-associated immune thrombocytopenia in Waldenström macroglobulinemia

IgG-associated immune thrombocytopenia in Waldenström macroglobulinemia

Use of the indirect platelet radioactive antiglobulin test with anti‐IgG and anti‐C3 in immune and nonimmune thrombocytopenias

Platelet‐associated immunoglobulins IgG, IgM, IgA and complement C3 in immune and nonimmune thrombocytopenic disorders

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Platelet‐Associated IgM Levels in Thrombocytopenia¹