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Vox Sang. 2020 Feb 20. doi: 10.1111/vox.12894. [Epub ahead of print]

Anti-platelet antibody immunoassays in childhood immune thrombocytopenia: a systematic review.

Author information

1
Sanquin Research, Department of Experimental Immunohematology, Amsterdam, The Netherlands.
2
Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
3
Department of Pediatric Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
4
Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
5
Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
6
Sanquin Research, Center for Clinical Transfusion Research, Leiden, The Netherlands.
7
Jon J van Rood Center for Clinical Transfusion Science, Leiden University Medical Center, Leiden, The Netherlands.
8
Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, The Netherlands.

Abstract

BACKGROUND:

In adult immune thrombocytopenia (ITP), an acquired autoimmune bleeding disorder, anti-platelet autoantibody testing may be useful as a rule-in test. Childhood ITP has different disease characteristics, and the diagnostic and prognostic value of anti-platelet antibody testing remains uncertain.

OBJECTIVE:

To systematically review the diagnostic accuracy of anti-platelet autoantibody testing in childhood ITP.

METHODS:

PubMed and EMBASE were searched for studies evaluating immunoassays in childhood ITP. Study quality was assessed (QUADAS2), and evidence was synthesized descriptively.

RESULTS:

In total, 40 studies (1606 patients) were identified. Nine studies reported sufficient data to determine diagnostic accuracy measures. Anti-platelet IgG antibody testing showed a moderate sensitivity (0·36-0·80 platelet-associated IgG [direct test]; 0·19-0·39 circulating IgG [indirect test]). In studies that reported control data, including patients with non-immune thrombocytopenia, specificity was very good (0·80-1·00). Glycoprotein-specific immunoassays showed comparable sensitivity (three studies) and predominantly identified IgG anti-GP IIb/IIIa antibodies, with few IgG anti-GP Ib/IX antibodies. Anti-platelet IgM antibodies were identified in a substantial proportion of children (sensitivity 0·62-0·64 for direct and indirect tests).

CONCLUSION:

The diagnostic evaluation of IgG and IgM anti-platelet antibodies may be useful as a rule-in test for ITP. In children with insufficient platelets for a direct test, indirect tests may be performed instead. A negative test does not rule out the diagnosis of ITP. Future studies should evaluate the value of anti-platelet antibody tests in thrombocytopenic children with suspected ITP.

KEYWORDS:

autoantibodies; clinical laboratory techniques; immune thrombocytopenia; paediatrics; systematic review

PMID:
32080872
DOI:
10.1111/vox.12894

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