Platelet kinetic studies in patients with idiopathic thrombocytopenic purpura

• Published in: The American journal of medicine Vol. 106; no. 4; pp. 430 - 434
• Main Authors: Louwes, Henk, Lathori, Oscar A.Zeinali, Vellenga, Edo, de Wolf, Joost Th.M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.1999; Elsevier; Elsevier Sequoia S.A
• Subjects: Adult; Aged; Biological and medical sciences; Blood; Blood Platelets; Cell Survival; Diagnosis, Differential; Disease; Female; Hematologic and hematopoietic diseases; Hemorrhage; Humans; Kinetics; Male; Medical research; Medical sciences; Middle Aged; Platelet diseases and coagulopathies; Predictive Value of Tests; Purpura, Thrombocytopenic, Idiopathic - blood; Purpura, Thrombocytopenic, Idiopathic - diagnosis; Human; Immunopathology; Evaluation; Platelet; Treatment; Idiopathic; Hemopathy; Diagnosis; Kinetic parameter; Immune thrombocytopenic purpura; Comparative study
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/S0002-9343(99)00054-6

PURPOSE: To determine the value in diagnosis and treatment of mean platelet life, platelet production, and major sites of platelet destruction in patients with idiopathic thrombocytopenic purpura (ITP). PATIENTS AND METHODS: Sternal or posterior superior iliac spine bone marrow aspiration was performed in 141 patients. Platelet kinetic studies with Indium-111 tropolonate labeled autologous platelets were utilized to determine platelet production. RESULTS: Two subgroups of patients could be defined. The first group (n = 81, 58%) had normal or increased platelet production and increased peripheral platelet destruction. These patients fulfilled the conventional criteria for ITP, including reduced platelet survival time (mean ± SD, 1.6 ± 1.4 days). Forty-eight (59%) of these patients had increased splenic sequestration and 30 (88%) of the 34 patients who underwent splenectomy had a complete or partial remission. The second group (n = 60, 42%) had decreased platelet production, with significantly greater platelet survival times (3.6 ± 2 days, P <0.0001). In this group, the proportion of patients with complete or partial response to splenectomy (62%) was somewhat lower ( P = 0.09). These patients mainly had ineffective platelet production in the bone marrow. CONCLUSIONS: Platelet kinetic studies suggest that ITP is a heterogeneous disease that comprises two subgroups. Further studies are needed to validate these findings and to determine their effect on the choice and outcome of therapy.