03421nas a2200397   4500008004100000020001400041024001700055245007800072210006900150260008200219300001300301490000700314520221000321653004602531653003602577653001502613653001002628653003502638653003802673653002002711653001002731653002102741653001102762653001502773653003702788653001102825653000902836653001602845653003202861100001602893700001302909700001902922700001402941700001902955856004902974       1989                        eng d  a0006-4971  aa8g, 760350900aGraft-v-host disease is associated with autoimmune-like thrombocytopenia.0 aGraftvhost disease is associated with autoimmunelike thrombocyto  aUNITED STATESbAnasetti,C. Puget Sound Blood Center, Seattle, WA 98104.c1989  a1054 - 80 v733 aPersistent thrombocytopenia after allogeneic marrow transplantation is associated with poor patient survival. To identify the mechanisms of the thrombocytopenia, we studied platelet and fibrinogen kinetics and antiplatelet antibodies in 20 patients between 60 and 649 days (median 90) after transplantation. Seventeen patients had isolated thrombocytopenia (less than 100 X 10(9) platelets/L): the marrow cellularity was normal in five patients and slightly reduced in 12, and there was no discrepancy between thrombopoiesis and myeloerythropoiesis. Three patients had pancytopenia following marrow graft rejection (two) and relapse of leukemia (one). Only three patients had evidence of increased platelet production, indicating that in most cases there is a poor marrow response to thrombocytopenia early after marrow grafting. There was no correlation between platelet count and splenic pooling, suggesting that hypersplenism was an unlikely mechanism of the thrombocytopenia. Although there was a direct relationship between platelet count and platelet survival, the reduction in platelet survival was greater than what could be explained by the fixed platelet removal found in thrombocytopenic patients; this suggests increased platelet destruction. Seven patients had intercurrent infections that reduced both platelet and fibrinogen survivals. In addition, platelet antibodies bound to autologous or marrow donor platelets were present in five of the 12 patients studied. Patients with antiplatelet antibodies had lower platelet counts (30 +/- 10 X 10(9)/L v. 49.1 +/- 28.7 X 10(9)/L, P less than 0.05) and platelet survivals (1.32 +/- 0.92 days v. 3.58 +/- 2.02 days, P less than 0.05) than patients without antiplatelet antibodies. Furthermore, platelet-bound autoantibodies were present in five of six patients with grade II-IV acute or chronic graft-versus-host disease (GVHD), but were not present in six patients free of GVHD (P less than 0.01). We conclude that persistent thrombocytopenia after marrow transplantation is most often secondary to increased platelet destruction mediated by multiple mechanisms and that platelet autoantibodies are found in patients with acute or chronic GVHD.10a*Graft vs Host Disease/co [Complications]10a*Thrombocytopenia/et [Etiology]10aAdolescent10aAdult10aAutoimmune Diseases/bl [Blood]10aAutoimmune Diseases/et [Etiology]10aBlood Platelets10aChild10aChild, Preschool10aFemale10aFibrinogen10aGraft vs Host Disease/bl [Blood]10aHumans10aMale10aMiddle Aged10aThrombocytopenia/bl [Blood]1 aAnasetti, C1 aRybka, W1 aSullivan, K, M1 aBanaji, M1 aSlichter, S, J  uhttps://www.notifylibrary.org/reference/4422