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Rheumatology Advance Access originally published online on January 17, 2006
Rheumatology 2006 45(7):851-854; doi:10.1093/rheumatology/kel010
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Two types of autoantibody-mediated thrombocytopenia in patients with systemic lupus erythematosus

M. Kuwana, J. Kaburaki2, Y. Okazaki, H. Miyazaki3 and Y. Ikeda1

Division of Rheumatology and 1 Division of Haematology, Department of Internal Medicine, Keio University School of Medicine, 2 Department of Internal Medicine, Tokyo Electric Power Company Hospital, Tokyo and 3 Kirin Brewery Company Ltd., Takasaki, Japan.

Correspondence to: Masataka Kuwana, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. E-mail: kuwanam{at}sc.itc.keio.ac.jp

Objectives. To determine whether autoantibodies to two platelet-specific antigens, glycoprotein IIb/IIIa (GPIIb/IIIa) and thrombopoietin receptor (TPOR), contribute to thrombocytopenia in patients with systemic lupus erythematosus (SLE).

Methods. Circulating B cells producing anti-GPIIb/IIIa antibodies and serum anti-TPOR antibodies were measured in 32 SLE patients with thrombocytopenia, 30 SLE patients without thrombocytopenia, 92 patients with idiopathic thrombocytopenia and 60 healthy controls. The megakaryocyte density in bone-marrow smears from all the patients with thrombocytopenia was evaluated.

Results. Anti-GPIIb/IIIa and anti-TPOR antibody responses were more frequent in SLE patients with thrombocytopenia than in those without thrombocytopenia (88 vs 17%, P<0.0001; and 22% vs 0%, P=0.01, respectively). The frequencies of these platelet-related antibodies were comparable between SLE patients with thrombocytopenia and patients with idiopathic thrombocytopenia. Twenty-nine (91%) SLE patients with thrombocytopenia had either anti-GPIIb/IIIa or anti-TPOR antibody, and six had both. In SLE patients with thrombocytopenia, the anti-TPOR-positive patients had significantly higher frequencies of megakaryocytic hypoplasia and poorer therapeutic responses to corticosteroids and intravenous immunoglobulin than did the anti-TPOR-negative patients, most of whom had the anti-GPIIb/IIIa antibody alone.

Conclusions. Anti-GPIIb/IIIa and anti-TPOR antibodies are major factors contributing to SLE-associated thrombocytopenia, but the clinical presentations associated with these autoantibodies are different.

KEY WORDS: Autoantibodies, Glycoprotein IIb/IIIa, Systemic lupus erythematosus, Thrombocytopenia, Thrombopoietin receptor


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