Background/Aim: The aim of this study was to evaluate the levels of platelet-associated antibodies (PAIgG and PAIgM), activated platelets and serum leptin in children with acute immune thrombocytopenic purpura (ITP). Methods: The study included 40 patients with ITP and 40 healthy age- and sex-matched controls. PAIgG, PAIgM and activated platelet levels were estimated by flow cytometry, and serum leptin levels were estimated by ELISA. Results: Activated platelets and serum leptin were significantly higher in the ITP patients than in the controls. The percentage and mean florescence intensity of PAIgG and PAIgM staining were significantly higher in the patients than in the controls. Serum leptin and activated platelet levels in patients with thrombocytopenia of brief duration were significantly lower than those in patients with thrombocytopenia of prolonged duration. The levels of activated platelets, serum leptin and PAIgG were positively correlated, and the levels of serum leptin, activated platelets and platelet counts were negatively correlated. Conclusion: The increased levels of activated platelets, serum leptin and platelet-associated antibodies in children with acute ITP suggest that these factors could play a role in ITP pathogenesis. Additionally, activated platelets and serum leptin could have prognostic significance in paediatric acute ITP.

Keywords:
Leptin, Platelet antibodies, Thrombocytopenic purpura
1.
Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper H, Godeau B, Lechner K, Mazzucconi MG, McMillan R, Sanz MA, Imbach P, Blanchette V, Kühne T, Ruggeri M, George JN: Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009;113:2386-2393.
2.
Semple JW: Immune pathophysiology of autoimmune thrombocytopenic purpura. Blood Rev 2002;16:9-12.
3.
Cines DB, Blanchette VS: Immune thrombocytopenic purpura. N Engl J Med 2002;346:995-1008.
4.
Stasi R, Evangelista ML, Stipa E, Buccisano F, Venditti A, Amadori S: Idiopathic thrombocytopenic purpura: current concepts in pathophysiology and management. Thromb Haemost 2008;99:4-13.
5.
Cooper N, Bussel J: The pathogenesis of immune thrombocytopenic purpura. Br J Haematol 2006;133:364-374.
6.
McFarland J: Pathophysiology of platelet destruction in immune (idiopathic) thrombocytopenic purpura. Blood Rev 2002;16:1-2.
7.
Cioffi JA, Shafer AW, Zupancic TJ, Smith-Gbur J, Mikhail A, Platika D, Snodgrass HR: Novel B219/OB receptor isoforms: possible role of leptin in hematopoiesis and reproduction. Nat Med 1996;2:585-589.
8.
Matarese G, Di Giacomo A, Sanna V, Lord GM, Howard JK, Di Tuoro A, Bloom SR, Lechler RI, Zappacosta S, Fontana S: Requirement for leptin in the induction and progression of autoimmune encephalomyelitis. J Immunol 2001;166:5909-5916.
9.
Jy W, Horstman LL, Park H, Mao WW, Valant P, Ahn YS: Platelet aggregates as markers of platelet activation: characterization of flow cytometric method suitable for clinical applications. Am J Hematol 1998;57:33-42.
10.
Panzer S, Höcker L, Vormittag R, Rieger M, Koren D, Dunkler D, Pabinger I: Flow cytometric evaluation of platelet activation in chronic autoimmune thrombocytopenia. Pediatr Blood Cancer 2006;47:694-696.
11.
Severinsen MT, Engebjerg MC, Farkas DK, Jensen A, Norgaard M, Zhao S, Sørensen HT: Risk of venous thromboembolism in patients with primary chronic immune thrombocytopenia: a Danish population-based cohort study. Br J Haematol 2011;152:360-362.
12.
Cuker A, Cines DB: Immune thrombocytopenia. Hematology Am Soc Hematol Educ Program 2010;2010:377-384.
13.
Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Busse JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B, Grainger J, Greer I, Hunt BJ, Imbach PA, Lyons G, McMillan R, Rodeghiero F, Sanz MA, Tarantino M, Watson S, Young J, Kuter DJ: International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010;115:168-186.
14.
Edslev PW, Rosthøj S, Treutiger I, Rajantie J, Zeller B, Jonsson OG, NOPHO ITP Working Group: A clinical score predicting a brief and uneventful course of newly diagnosed idiopathic thrombocytopenic purpura in children. Br J Haematol 2007;138:513-516.
15.
Yildirmak Y, Yanikaya-Dimirel G, Palanduz A, Kayaalp N: Antiplatelets antibodies and their correlation with clinical findings in childhood immune thrombocytopenic purpura. Acta Haematol 2006;116:75-76.
16.
Shao JF, Zhan QG, Liu ZM, Zhong YG, Guan YL, Fu JP, Feng WY, Lou DJ: Significance of detecting platelet associated antibody and platelet membrane glycoprotein for diagnosis of immune thrombocytopenia (in Chinese). Zhongguo Shi Yan Xue Ye Xue Za Zhi 2004;12:224-227.
17.
Romero-Guzmán LT, López-Karpovitch X, Paredes R, Barrales -Benitez O, Piedras J: Detection of platelet-associated immunoglobulins by flow cytometry for the diagnosis of immune thrombocytopenia: a prospective study and critical review. Haematologica 2000;85:627-631.
18.
Corash L, Rheinschmidt M: Detection of platelet antibodies with a fluorescence activated flow cytometric technique; in Rose NR, Friedman H, Fahey JL (eds): Manual of Clinical Laboratory Immunology, ed 3. Washington, American Society for Microbiology, 1986, pp 254-257.
19.
Rosenfeld CS, Nichols G, Bodensteiner DC: Flow cytometric measurement of antiplatelet antibodies. Am J Clin Pathol 1987;87:518-522.
20.
Kahng J, Park HH, Han K, Choi BY, Lee W: Quantitative comparisons of antibody-binding sites of platelet glycoprotein IIb/IIIa in aplastic anemia and idiopathic thrombocytopenic purpura. Ann Clin Lab Sci 2008;38:6-11.
21.
Ren H, Zhao H, Wang T, Yang Y, Han Z, Liu B, Wu Z, Tao J, Zhou B, Zhang L, Yang R, Han ZC: Leptin enhances in vitro secretion of IgG antiplatelet antibodies by splenocytes and peripheral blood mononuclear cells from patients with chronic idiopathic thrombocytopenic purpura. Clin Immunol 2006;120:205-211.
22.
Dellas C, Schäfer K, Rohm IK, Lankeit M, Leifheit M, Loskutoff DJ, Hasenfuss G, Konstantinides SV: Leptin signalling and leptin-mediated activation of human platelets: importance of JAK2 and the phospholipases Cγ2 and A2. Thromb Haemost 2007;98:1063-1071.
23.
Zhan M, Zhao H, Yang R, Han ZC: Serum leptin level in patients with idiopathic thrombocytopenic purpura. Eur J Haematol 2004;72:348-352.
24.
Mouzaki AM, Theodoropoulou M, Vlaha V, Maniatis AK: Leptin levels in childhood idiopathic thrombocytopenic purpura (ITP) correlate with disease activity (abstract). 10th Congress of the European Hematology Association, Stockholm, 2006.
25.
Yanabu M, Nomura S, Fukuroi T, Soga T, Kondo K, Sone N, Kitada C, Nagata H, Kokawa T, Yasunaga K: Synergistic action in platelet activation induced by an antiplatelet autoantibody in ITP. Br J Haematol 1991;78:87-93.
26.
Panzer S, Rieger M, Vormittag R, Eichelberger B, Dunkler D, Pabinger I: Platelet function to estimate the bleeding risk in autoimmune thrombocytopenia. Eur J Clin Invest 2007;37:814-819.
27.
Hayashi S, Oshida M, Kiyokawa T, Aochi H, Honda S, Tomiyama Y, Kurata Y: Determination of activated platelets: evaluation of methodology and application for patients with idiopathic thrombocytopenic purpura (in Japanese). Rinsho Byori 2001;49:1287-1292.
28.
Elbatarny SH, Maurice DH: Leptin-mediated activation of human platelets: involvement of a leptin receptor and phosphodiesterase 3A-containing cellular signaling complex. Am J Physiol Endocrinol Metab 2005;289:E695-E702.
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2013
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