Autoimmune-mediated thrombocytopenia after allogeneic hematopoietic stem cell transplantation: significance of detecting reticulated platelets and glycoprotein-specific platelet autoantibodies
Autoimmune-mediated thrombocytopenia after allogeneic hematopoietic stem cell transplantation: significance of detecting reticulated platelets and glycoprotein-specific platelet autoantibodies
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DOI：
10.1007/s12185-021-03272-x
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发表时间：
2022-01-17
影响因子：
2.1
通讯作者：
Kashiwagi, Hirokazu
中科院分区：
文献类型：
--
作者：
Akuta, Keigo;Fukushima, Kentaro;Kashiwagi, Hirokazu
自身免疫性血液病是异基因造血干细胞移植（allo-HSCT）后罕见的并发症。免疫性血小板减少症（ITP）的诊断具有挑战性，特别是在allo-HSCT后，因为各种并发症，如移植物抗宿主病、疾病复发、病毒感染、血栓性微血管病和药物副作用也可引起血小板减少症。评估网织血小板（RP）和血浆血小板生成素（TPO）水平可能有助于区分ITP和发育不良性血小板减少症。ITP通常以RP百分比增加和血浆TPO水平正常或略微增加为特征。我们现在报告3例异基因造血干细胞移植后血小板减少症。这些患者的RP%升高，与原发性ITP相同。然而，与原发性ITP相比，三名患者中有两名患者血浆TPO水平较高。还检测到抗α IIb β 3和抗GPIb/IX特异性直接IgG抗体，表明2例患者除骨髓抑制外还发生免疫介导的血小板破坏。所有3例患者均成功接受皮质类固醇和/或血小板生成素受体激动剂（TPO-RA）治疗。提示RP%升高和血小板糖蛋白特异性自身抗体检测对HSCT后ITP的诊断有一定的参考价值。
Autoimmune hematological disorders are rare complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Diagnosis of immune thrombocytopenia (ITP) is challenging, especially after allo-HSCT, because various complications such as graft-versus-host disease, disease relapse, viral infection, thrombotic microangiopathy, and drug side effects can also cause thrombocytopenia. Assessment of reticulated platelets (RP) and plasma thrombopoietin (TPO) levels may be useful to distinguish between ITP and hypoplastic thrombocytopenia. ITP is generally characterized by an increased percentage of RP, and a normal or slightly increased plasma TPO level. We now report three cases of thrombocytopenia after allo-HSCT. RP% was elevated in these patients, as it is in primary ITP. However, in contrast to primary ITP, plasma TPO levels were high in two of three patients. Anti-alpha IIb beta 3 and anti-GPIb/IX-specific direct IgG antibodies were detected as well, suggesting occurrence of immune-mediated platelet destruction in addition to bone marrow suppression in two patients. All three patients were successfully treated with corticosteroids and/or thrombopoietin receptor agonists (TPO-RAs). These results suggest that increased RP% and detection of glycoprotein-specific platelet autoantibodies are useful for the diagnosis of ITP after HSCT.