Discussion
Bleeding is the only clinical manifestation of ITP and varies from mild
skin mucosal hemorrhage to severe intracranial hemorrhage. Severe
bleeding not only affects the quality of life but also threatens life in
children with ITP. Therefore, it is important to explore the influencing
factors of bleeding in ITP. GPIIb/IIIa and GPIb/IX mediate platelet
aggregation and adhesion and play an important role in hemostasis. The
antibodies could theoretically aggravate bleeding symptoms in ITP
patients. However, previous studies that elucidated the relationship
between the platelet-specific antibodies and bleeding severities,
reached different conclusions. Nomura et al.9 reported
that patients with anti-GPIb/IX antibodies had more severe bleeding
manifestations than patients without anti-GPIb/IX antibodies. Mehta et
al.10found that patients with both anti-GPIIb/IIIa and
anti-GPIb/IX antibodies were more prone to develop moderate or severe
bleeding symptoms than patients with only one antibody or without
antibodies. Al-Samkari et al.11found a statistically
significant predictive relationship between the increasing number of
positive autoantibodies and disease severity. Fu et al.8 from our research group found no significant
difference in the degree of bleeding between different types of
platelet-specific antibodies. However, that study focused on the
relationship between platelet-specific antibodies and glucocorticoid
response, but less on bleeding, and did not exclude the influence of
platelet count and chronic ITP on bleeding. Therefore, whether
platelet-specific antibodies result in severe bleeding manifestation
requires more evidence.
Our study was a prospective and observational cohort study. The enrolled
cases were all diagnosed according to the international consensus
guidelines and did not have a history of taking special platelet
elevation drugs before the detection of platelet-specific antibodies.
The baseline platelet counts in all cases were less than
10×109/L to eliminate the influence of platelet count
on bleeding. We detected platelet-specific antibodies in both plasma and
eluent and analyzed antibodies’ levels qualitatively and quantitatively
to ensure a more accurate and credible conclusion of the relationship
between platelet-specific antibodies and bleeding severities.
Our data demonstrated that there was no significant difference in the
distribution of platelet-specific antibodies between the two bleeding
severity groups, and also displayed no difference in antibody titer
ratios between the two bleeding severity groups in both plasma and
eluent. Finally, we concluded that platelet-specific antibodies
(anti-GPIIb/IIIa and anti-GPIb/IX antibodies) were not related to the
bleeding severities in children with newly diagnosed ITP with serious
decline of platelet count.
Authorship Contributions: All authors contributed to the study
conception and design. Material preparation, data collection and
analysis were performed by Shuyue Dong, Linging Fu, Xingjuan Xie and Hao
Gu; Hao Gu and Xingjuan Xie did the sample collection and antibody
test;Lingling Fu, JingyaoMa and Jie Ma recruited all the subjects and
collected the written informed consents;The first draft of the
manuscript was written by Shuyue Dong and all authors commented on
previous versions of the manuscript. Runhui Wu and Zhenping Chen read
and approved the final manuscript.
Acknowledgements: None.