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antiplatelet antibodyHematology An auto- or alloantibody directed against platelet antigens, which may be measured in thrombocytopenia or in Pts who are refractory to platelet transfusions. See Platelet transfusion.
Synonym/acronym: Antiplatelet antibody; platelet-bound IgG/IgM, direct and indirect.
To assess for the presence of platelet antibodies to assist in diagnosing thrombocytopenia related to autoimmune conditions and platelet transfusion compatibility issues.
SpecimenSerum (1 mL) collected in a red-top tube for indirect immunoglobulin G (IgG) antibody. Whole blood (7 mL) collected in a lavender (EDTA)-, yellow (ACD)-, or pink (K2EDTA)-top tube for direct antibody.
(Method: Solid-phase enzyme-linked immunoassay) Negative.
Platelet antibodies can be formed by autoimmune response, or they can be acquired in reaction to transfusion products or medications. Platelet autoantibodies are immunoglobulins of autoimmune origin (i.e., immunoglobulin G [IgG]), and they are present in various autoimmune disorders, including thrombocytopenias. Platelet alloantibodies develop in patients who become sensitized to platelet antigens of transfused blood. As a result, destruction of both donor and native platelets occurs along with a shortened survival time of platelets in the transfusion recipient. The platelet antibody detection test is also used for platelet typing, which allows compatible platelets to be transfused to patients with disorders such as aplastic anemia and cancer. Platelet typing decreases the alloimmunization risk resulting from repeated transfusions from random donors. Platelet typing may also provide additional support for a diagnosis of post-transfusional purpura.
This procedure is contraindicated for
- Assist in the detection of platelet alloimmune disorders
- Determine platelet type for refractory patients
Development of platelet antibodies is associated with autoimmune conditions and medications.
- AIDS (related to medications used therapeutically)
- Acute myeloid leukemia (related to medications used therapeutically)
- Idiopathic thrombocytopenic purpura (related to development of platelet-associated IgG antibodies)
- Immune complex diseases
- Multiple blood transfusions (related in most cases to sensitization to PLA1 antigens on donor red blood cells that will stimulate formation of antiplatelet antibodies)
- Multiple myeloma (related to medications used therapeutically)
- Neonatal immune thrombocytopenia (related to maternal platelet–associated antibodies directed against fetal platelets)
- Paroxysmal hemoglobinuria
- Rheumatoid arthritis (related to medications used therapeutically)
- Systemic lupus erythematosus (related to medications used therapeutically)
- Thrombocytopenias provoked by drugs (see monograph titled “Complete Blood Count, Platelet Count”)
- There are many drugs that may induce immune thrombocytopenia (production of antibodies that destroy platelets in response to the drugs). The most common include acetaminophen, gold salts, heparin (Type II HIT), oral diabetic medications, penicillin, quinidine, quinine, salicylates, sulfonamides, and sulfonylurea.
- There are many drugs that may induce nonimmune thrombocytopenia (effect of the drug includes bone marrow suppression or nonimmune platelet destruction). The most common include anticancer medications (e.g., bleomycin), ethanol, heparin (Type I HIT), procarbazine, protamine, ristocetin, thiazide, and valproic acid.
- Hemolyzed or clotted specimens will affect results.
Nursing Implications and Procedure
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Patient Teaching: Inform the patient this test can assist in evaluating for issues related to platelet compatibility.
- Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
- Obtain a history of the patient’s hematopoietic and immune systems, especially any bleeding disorders and other symptoms, as well as results of previously performed laboratory tests and diagnostic and surgical procedures.
- Obtain a list of the patient’s current medications, including anticoagulants, aspirin and other salicylates, herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values). Note the last time and dose of medication taken.
- Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Note that there are no food, fluid, or medication restrictions unless by medical direction.
- Potential complications: N/A
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
- Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
- Promptly transport the specimen to the laboratory for processing and analysis.
- Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
- Note the patient’s response to platelet transfusions.
- Instruct the patient to report severe bruising or bleeding from any areas of the skin or mucous membranes.
- Recognize anxiety related to test results, and discuss the implications of abnormal test results on the patient’s lifestyle. Help patients who have a bleeding disorder understand the importance of taking precautions against bruising and bleeding. Provide education for precautions to include the use of a soft-bristle toothbrush, use of an electric razor, and avoidance of constipation, intramuscular injections, and acetylsalicylic acid (and similar products).
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Related tests include angiography abdominal, biopsy bone marrow, bleeding time, clot retraction, CBC platelet count, CT brain, Ham’s test, hemosiderin, and LAP.
- Refer to the Hematopoietic and Immune systems tables at the end of the book for related tests by body system.
specialized serum proteins produced by B lymphocytes in response to an immense number of different antigens (>107) to which an animal may be exposed. Antibody produced by a particular antigen combines with that antigen only. The exquisite specificity of Ab for the antigen that stimulated its production is the basis for all antibody-antigen reactions both in vivo and in vitro. Antibodies are heterodimers composed of two light (L) and two heavy (H) chain polypeptide molecules. The amino termini of the L and H chains have a variable amino acid sequence VL and VH. The specificity of Ab for Ag is conferred by the VL and VH domains. There are five major classes of antibody, designated IgG, IgM, IgA, IgD and IgE. Abbreviated Ab or Ig. Called also immunoglubulin or gamma globulin. See also immunity.
affinity purification of antibody
antibody, usually IgE, formed after the first injection of certain allergens and responsible for the signs of anaphylaxis following subsequent exposures to the same allergen.
the specific combination of antigen with homologous antibody resulting in the reversible formation of antibody-antigen complexes that differ in composition according to the antibody-antigen ratio. See also antigen.
antinuclear antibody (ANA)
autoantibodies directed against components of the cell nucleus, e.g. DNA, RNA and histones; they may be detected by immunofluorescence. A positive ANA test is characteristic of systemic lupus erythematosus, Sjögren's syndrome and rheumatoid arthritis.
antibodies against the antibody variable region.
those produced against an immunoglobulin, often used as reagents to study immunoglobulin molecules.
see antiplatelet antibody.
produced following entry of sperm into the bloodstream, e.g. following rupture of the epididymis as in Brucella ovis infections.
circulating antibody (usually IgG) that reacts preferentially with an antigen, preventing it from reacting with a cell-bound antibody (IgE) and blocking the induction of anaphylaxis.
clone specific antibody.
see cold agglutinin.
immunoglobulins of the IgG or IgM class which bind complement.
one that combines with an antigen other than, but structurally related to, the one that induced its production.
cytotropic antibody (below).
that which binds antigens expressed on the cell surface, which may (a) activate the complement pathway or (b) activate killer cells, resulting in cell lysis.
those that attach to tissue cells (such as IgE to mast cells and basophils) that have an Fc receptor.
antibody-dependent cell-mediated cytotoxicity (ADCC)
a cytotoxic reaction in which nonsensitized cells bearing Fc receptors recognize target cells that have antibody bound to antigen exposed in the cell membrane of the target cell.
see fluorescence microscopy.
one with greater affinity for an antigen other than the one that stimulated its formation.
has been investigated mostly as a means of controlling fertility in animals. See also contraception.
see humoral immunity.
one induced by immunization or by transfusion incompatibility, in contrast to natural antibodies.
an antibody which combines with antigen without producing an observable reaction such as agglutination; originally used to describe Rh antibodies.
those passively transferred from dam to fetus or neonate, transplacentally or via colostrum or yolk sac. See also passive immunity.
damage to cells, especially erythrocytes, caused by the reaction of antibodies (IgG, IgM or IgA) with cell surface antigens.
see monoclonal antibodies.
ones that react with antigens to which the individual has had no known exposure. The best examples are anti a and b antibodies present in serum of humans of blood group B and A, respectively.
one that reduces, destroys or blocks infectivity of an infectious agent, particularly virus, by partial or complete destruction of the agent.
see incomplete antibody (above).
a collection of immunoglobulins that react against the same or different antigenic determinants of the one antigen molecule.
one responsible for immunity to an infectious agent.
all the antibody specificities that can be produced by an individual.
see incomplete antibody (above).
directed against or destructive to blood platelets; inhibiting platelet function.
the prevention of thromboembolic disorders in animals is limited mainly to the treatment of cats with arterial thromboembolism and dogs with heartworms. Platelet aggregation may be impeded by treatment with aspirin, dipyrimadole, sulfinpyrazone or propranolol.