Protein A Sepharose immunoadsorption can restore the efficacy of platelet concentrates in patients with Glanzmann's thrombasthenia and anti-glycoprotein IIb-IIIa antibodies

被引:30
作者
Martin, I
Kriaa, F
Proulle, VR
Guillet, B
Kaplan, C
d'Oiron, R
Debré, M
Fressinaud, E
Laurian, Y
Tchernia, G
Charpentier, B
Lambert, T
Dreyfus, M
机构
[1] CHU Kremlin Bicetre, Assistance Publ Hop Paris, Hematol Lab, Ctr Traitement Hemophilie, Le Kremlin Bicetre, France
[2] CHU Kremlin Bicetre, Assistance Publ Hop Paris, Serv Nephrol, Le Kremlin Bicetre, France
[3] Fac Med Paris 11, Le Kremlin Bicetre, France
[4] Hop Necker Enfants Malad, INTS, Lab Immunol Plaquettaire, Paris, France
[5] Hop Necker Enfants Malad, Unite Hematol & Immunol Pediat, Paris, France
[6] Ctr Hosp Reg Nantes, Hematol Lab, Nantes, France
关键词
Glanzmann's thrombasthenia; anti-glycoprotein IIb-IIIa isoantibodies; platelet transfusions; immunoadsorption on protein A-Sepharose; platelet glycoprotein GPIIb-IIIa;
D O I
10.1046/j.1365-2141.2002.03936.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Type I Glanzmann's thrombasthenia is a rare congenital platelet function disorder, characterized by undetectable platelet membrane glycoprotein IIb-IIIa (GPIIb-IIIa). Severe bleeding is controlled by transfusion of normal platelets, leading in some cases to the occurrence of anti-GPIIb-IIIa isoantibodies, which induces a loss of transfused platelet efficacy. We used immunoadsorption on protein A Sepharose (IA-PA), which has been shown to be efficient in decreasing the titre of antibodies in several immune diseases, in three patients with Glanzmann's thrombasthenia and anti-GPIIb-IIIa isoantibodies on five different occasions. IA-PA was well tolerated with no deleterious side-effects reported. It induced a dramatic decrease of total immunoglobulin (Ig)G, including anti-GPIIb-IIIa isoantibody levels, as assessed by the monoclonal antibody-specific immobilization of platelet antigens test and the ex vivo inhibition of normal platelet aggregation induced by the patient's platelet-rich or platelet-poor plasma. Elimination of the antibody was associated with a correction of the bleeding time following platelet transfusion. IA-PA combined with platelet transfusion made it possible to control two life-threatening haemorrhages, and allowed two surgical procedures and one bone marrow transplantation to be performed safely. Our experience suggests that IA-PA, which restores the haemostatic efficacy of platelet transfusion, is a valuable therapeutic strategy in patients with Glanzmann's thrombasthenia and anti-GPIIb-IIIa isoantibodies.
引用
收藏
页码:991 / 997
页数:7
相关论文
共 29 条
[1]   Mycophenolate mofetil and its mechanisms of action [J].
Allison, AC ;
Eugui, EM .
IMMUNOPHARMACOLOGY, 2000, 47 (2-3) :85-118
[2]   Bone marrow transplantation in severe Glanzmann's thrombasthenia with antiplatelet alloimmunization [J].
Bellucci, S ;
Damaj, G ;
Boval, B ;
Rocha, V ;
Devergie, A ;
Agha, IY ;
Garderet, L ;
Ribaud, P ;
Traineau, R ;
Socié, G ;
Gluckman, E .
BONE MARROW TRANSPLANTATION, 2000, 25 (03) :327-330
[3]   Clinical evaluation of a staphylococcal protein A immunoadsorption system in the treatment of myasthenia gravis patients [J].
Benny, WB ;
Sutton, DMC ;
Oger, J ;
Bril, V ;
McAteer, MJ ;
Rock, G .
TRANSFUSION, 1999, 39 (07) :682-687
[4]   ELECTIVE SURGERY IN A HEMOPHILIC PATIENT WITH HIGH TITER INHIBITORS - USE OF EXTRACORPOREAL PROTEIN-A IMMUNOABSORPTION [J].
BOUGHTON, BJ ;
PAYNE, A ;
SERMAN, A ;
OWEN, C .
JOURNAL OF CLINICAL PATHOLOGY, 1990, 43 (02) :172-172
[5]   Immunoadsorption onto protein A induces remission in severe systemic lupus erythematosus [J].
Braun, N ;
Erley, C ;
Klein, R ;
Kötter, I ;
Saal, J ;
Risler, T .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2000, 15 (09) :1367-1372
[6]   CONGENITAL BLEEDING DISORDERS WITH LONG BLEEDING TIME AND NORMAL PLATELET COUNT .I. GLANZMANNS THROMBASTHENIA (REPORT OF 15 PATIENTS) [J].
CAEN, JP ;
CASTALDI, PA ;
LECLERC, JC ;
INCEMAN, S ;
LARRIEU, MJ ;
PROBST, M ;
BERNARD, J .
AMERICAN JOURNAL OF MEDICINE, 1966, 41 (01) :4-&
[7]  
d'Oiron R, 2000, THROMB HAEMOSTASIS, V83, P644
[8]  
FISCHER A, 1991, CHEM IMMUNOL, V50, P89
[9]   AN IGG INHIBITOR AGAINST COAGULATION FACTOR-XIII - RESOLUTION OF BLEEDING AFTER PLASMA IMMUNOADSORPTION WITH STAPHYLOCOCCAL PROTEIN-A [J].
GAILANI, D .
AMERICAN JOURNAL OF MEDICINE, 1992, 92 (01) :110-112
[10]  
GEORGE JN, 1990, BLOOD, V75, P1383