The sensitivity and specificity of platelet autoantibody testing in immune thrombocytopenia: a systematic review and meta‐analysis of a diagnostic test
Author(s): ,
John R. Vrbensky
Affiliations:
Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
,
Joyce E. Moore
Affiliations:
Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
,
Donald M. Arnold
Affiliations:
Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada. McMaster Centre for Transfusion Research, Hamilton, Canada. Canadian Blood Services, Hamilton, Canada
,
James W. Smith
Affiliations:
Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
,
John G. Kelton
Affiliations:
Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada. McMaster Centre for Transfusion Research, Hamilton, Canada
Ishac Nazy
Affiliations:
Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada. McMaster Centre for Transfusion Research, Hamilton, Canada
Correspondence: Ishac Nazy, 1200 Main Street W, HSC Room 3H53, Hamilton, Ontario, L8S‐4K1, Canada|Tel.: +1 905 525 9140 extension 20242|E‐mail: nazii@mcmaster.ca
ISTH Academy. Nazi I. May 1, 2019; 273601
Ishac Nazi
Ishac  Nazi
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Background
Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet count and an increased risk of bleeding. The sensitivity and specificity of platelet autoantibody tests is variable and their utility is uncertain.
Objective
The purpose of this study was to perform a systematic review and meta‐analysis of platelet autoantibody tests in the diagnosis of ITP.
Methods
Ovid Medline, PubMed, and Web of Science were searched from inception until 31 May 2018. Two reviewers independently assessed studies for eligibility and extracted data. Studies that reported testing results for antiplatelet autoantibodies on platelets (direct tests) or in plasma/serum (indirect tests) for 20 or more ITP patients were included.
Results
Pooled estimates for sensitivity and specificity were calculated using a random effects model. Pooled estimates for the sensitivity and specificity of direct anti‐platelet autoantibody testing for either anti‐glycoprotein IIbIIIa or anti‐glycoprotein IbIX were 53% (95% confidence interval [CI], 44–61%) and 93% (95% CI, 81–99%), respectively. For indirect testing, the pooled estimates for the sensitivity and specificity were 18% (95% CI, 12–24%) and 96% (95% CI, 87–100%), respectively.
Conclusions
Autoantibody testing in ITP patients has a high specificity but low sensitivity. A positive autoantibody test can be useful for ruling in ITP, but a negative test does not rule out ITP.
Keyword(s)
autoantibodies, ITP , platelets, sensitivity, specificity
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