Key words: -TG RIA kit, thromboembolism, thrombocytopenia, thrombocytosis, vascular purpura The plasma concentration of the platelet-specific protein
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1 Key words: -TG RIA kit, thromboembolism, thrombocytopenia, thrombocytosis, vascular purpura The plasma concentration of the platelet-specific protein B-thromboglobulin (B- TG) was measured by the use of ", BTG RIA kit" (The Radiochemical Centre, Kakenkagaku) in patients with various disorders, including 12 patients with thromboembolism, 9 with prosthetic cardiac valves, 10 with diabetes mellitus, 18 with various thrombocytopenias, 15 with various thrombocytosis and one of each with von Willebrand's disease and vascular purpura as well as in 21 healthy control subjects. The mean concentration in control subjects was 23 ng/ml (range 8-50, S. D. 14). The inter-assay coefficient of variation (CV) and the intraassay CV of a single plasma sample were 17.3% (n=7) and 12.1% (n=12), respectively. Except for disseminated intravascular coagulation (DIC), all thrombocytopenic patients showed normal or low j3-tg levels. It was to be noted that j3-tg was not increased in idiopathic thrombocytopenic purpura (ITP) in which immunologically damaged platelets were presumed to be removed from the circulation in such a way that plasma, 9-TG was not elevated. Plasma B-TG Was increased in patients with primary thrombocytosis (myeloproliferative disorders), and similar but less marked change was observed in secondary thrombocytosis. Raised, S-TG levels were detected in most patients with recent thromboembolic episodes but not in those with old ones. One prosthetic valve patient and 3 diabetic patients with recent vascular complications showed high j3-tg levels but those without such complication had normal values. A patient with von Willebrand's disease showed a normal j3-tg level and that with vascular purpura had the raised ones. The studies documented a progressive rise and fall in plasma js-tg concentration following the onset of acute thromboembolism or DIC. However, persistently elevated levels were detected in patients with essential thrombocythemia and vascular purpura without clinical manifestations of thromboembolism. The investigations suggest that radioimmunoassay of j3-tg is
2 Blood & Vessel :541 a useful test to aid the diagnosis and treatment of patients with thromboembolic disorders as well as to understand pathophysiology of some platelet and vascular disorders.
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4 Blood & Vessel :543 (A)(B) Normalrange Fig. 2 p-tg concentrations of plasma in patients with thrombotic tendency. (A): Thromboembolism and prosthetic valve patients, (B): Diabetes mellitus. る. 以 上 の 成 績 か ら, 諸 家 に よ る血 栓 塞 栓 性 疾 患 に お け る成 績3)5)6)9)10)と 同 様 に, 血 小 板 の 関 与 した 血 管 閉 塞性 疾 患 な い し その よ う な合 併 症 の 診 断 や病 態 の把 握 に β一tg測 定の有用性が 示 唆 され た. しか し骨 髄 増 殖性 疾 患 や 血 管性 紫 斑病 で も β一tgは 増 加 す る もの が あ り, ま た 血 小板 の破 壊 を 伴 う と考 え られ るITPで 増加 しな い こ と な ど血 小 板 と血 漿 β一tg値 の 関係 が 単 純 でな い場 合 もあ り, β一tg増 加 に よ る血 栓 性 疾 患 の 診 断 に は 各 種 の検 査 成 績 や病 歴 を 含 む 総 合 的 判 断 が必 要 と考 え られ る III. 結 論 Normal 各 種 の 血 栓 塞栓 性 疾 患 の と くに そ の 急 性 期 に 血漿 β-tgの 増 加 が 認 め られ, そ の 経 時 的変 化 が病 態 の把 握 に有 用 な こ とが 示 唆 さ れ た. ITPで は β一tgの 増 加 は認 め られ ず, 骨 髄 増 殖 性 疾 患 や 血 管性 紫 斑病 に も β一tgの 高 値 を 呈 す る症 例 が 認 め られ た. した が って 血 漿 β一tg の測 定 は, そ の 高 値 を もた らす 特 殊 な因 子 や 他 の 疾 患 が 除外 され れ ば血 栓 性 疾 患 の 診 断 や 病 態 把 握 に有 用 な情 報 を提 供 す る も の と考 え られ range Fig. 3 B-TG levels during the course of diseases. Days when the first sample was taken from each patient are shown as 0. Diagnosis of patients are: 1) Cerebral infarction and transient ischemic attack, 2) Myocardial infarction and nephrosis, 3) Essential thrombocythemia, 4) Disseminated intrvascular coagulation (DIC) (metastatic cancer), 5) Henoch's purpura complicated with stillbirth and DIC, 6) von Willebrand's disease, 7) Vascular purpura.
5 1) Moor, S., Pepper, D. S. and Cash, J. D.: The isolation and chracterisation of a platelet-specific p-globulin (f3-thromboglobulin) and the detection of antiurokinase and antiplasmin released from thrombin-aggregated washed human platelets. Biochim. Biophys. Acta, 379; , ) Williams, A. R., Chater, B. V., Allen, K. A., Sherwood, M. R. and Sanderson, J. H.: Release of j3-thromboglobulin from human platelets by therapeutic intensities of ultrasound. Br. J. Haemtol., 40; , ) Ludlam, C. A., Moore, S., Bolton, A. E., Pepper, D. S. and Cash, J. D.: The release of a human platelet specific protein measured by a radioimmunoassay. Thromb. Res., 6; , ) Kaplan, K. L., Nossel, H. L., Drillings, M. and Lesznik, G.: Radioimmunoassay of platelet factor 4 and /3-thromboglobulin: Development and application to studies of platelet release in relation to fibrinopeptide A generation. Br. J. Haematol., 39; , ) Ludlam, C. A., Bolton, A. E., Moore, S. and Cash, J. D.: New rapid method for diagnosis of deep venous thrombosis. Lancet, 2; , ) Pepper, D. S. and Ludlam, C. A.: -thromboglobulin (3-TG)-A new approach to the diagnosis of thrombosis. in "Platelets and thrombosis" ed. by Mills, D. C. B. and Pareti, F. I., p , Academic Press, London, ) O'Brien, JR. and Etherington, M. D.: The platelets in glandular fever and idiopathic thrombocytopenic purpura. Br. J. Haematol., 43; , 1978 (correspondence). 8) Fuster, V., Bowie, E. J. W., Kazmier, F. J. and Owen, C. A., Jr.: Platelet consumption in chronically induced plasma platelet factor 4-like activity reflecting rate of intravascular coagulation in dogs. Thromb. 4; , Res., 9) Boughton, B. J., Allington, M. J. and King, A.: Platelet and plasma ;3 thromboglobulin in myeloproliferative syndromes and secondary thrombocytosis. Br. J. Haematol., 40; , ) Preston, F. E., Ward, J. D., Marcola, B. H., Porter, N. R., Timperley, W. R. and O'Malley, B. C.: Elevated B-thromboglobulin levels and circulating platelet aggregates in diabetic microangiopathy. Lancet, 1; , 1978.
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