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Thrombocytopenia is a common hematological disorder in both children and adults. Immune or idiopathic thrombocytopenia purpura (ITP) is the most comment causes of immunemediated thrombocytopenia in children. It can be caused by non-immune causes such as apalastic anemia. In majority of cases the diagnosis is made clinically with the aid of limited laboratory investigations. The purpose of this study was to evaluate whether measuring platelet associated immunoglobulins (PAIg’s); IgG and IgM with complement 3 (C3) would make a useful tool in diagnosing the cause of thrombocytopenia. It was a retrospective study of children with a diagnosis of thrombocytopenia. Their charts were reviewed in regard to age, sex, platelet count at the time of the diagnosis, and the treatment received. They were classifieds into primary and secondary types. The primary type included those with acute ITP (AITP) (n= 7) and chronic ITP (CITP) (n= 25) whereas the secondary type included those with thrombocytopenia due to other causes (n= 31). Furthermore, the thrombocytopenic episodes were reclassified into immune and non-immune mediated thrombocytopenia (n= 48) and (n= 29) respectively. A total of 63 children with 77 thrombo-cytopenic episodes were studied. Direct flow cytometry technique was used to measure the platelet associated IgG (PAIgG), platelet associated IgM (PAIgM), and platelet associated complement 3 (PAC3). Results of PAIgm in AITPand CITP were positive for 80 % and 63 % of cases respectively, while in secondary it was positive for 40 % of cases only. In case of immune and non-immune thrombocytopenia, the positivity of PAIgM occurred in 63 % and 34 % of cases. The results of pAIgG and PAC3 were also found positive inAITP, CITP, immune and non-immune thrombocytopenia but nonconclusive. Conclusion: These results indicate that measurement of PAIg’s and PAC3in children with thrombocytopenia is not accurate and often fails to discriminate between the different causes of thrombocytopenia. Diagnosis of thrombocytopenia remains mainly clinical, and measuring of platelet associated antibodies is not recommended in clinical practice.
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Author(s): Hassan Ali AlTrabolsi
thrombocytopenia, children, autoantibodies