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Test Name:
Drug-Dependent Platelet Antibody

• SBMF No:
  45269
• Performance Lab Name:
  BloodCenter of Wisconsin
• Test Mnemonic:
  PLTAB-DRUG
• ABN:
  Not required
• CPT Code:
  86022x4 (1-3 drugs); Add 86022x2 for each additional drug tested
• Ref Lab Test No:
  9000
• Also Known As:
  Platelet Antibody, Drug-Dependent
• Spec Type:
  Serum
• Spec Container:
  Red top (serum) tube
• Alt Spec Type:
  Plasma
• Alt Spec Container:
  Light blue top (3.2% buffered sodium citrate) tube
• Pref Vol:
  5.0 mL
• Min Vol:
  1.0 mL
• Fasting:
  No
• Spec Collect:
  Routine venipuncture
• Spec Process:
  Serum sample tubes, clot 30 minutes
  Promptly centrifuge 15 minutes
  Immediately transfer serum or plasma to separate plastic tube
• Spec Store Transport:
  Refrigerated
• Spec Stability:
  1 week refrigerated (2-8°C)
  1 week frozen (-20°C) – Do not use frost-free units that undergo repeated freeze/thaw cycles
• Spec Remarks:
  Please provide a list of drugs to be tested. Additional charges and CPTs will apply if testing is requested for more than three drugs.
• Methodology:
  Immunofluorescence by Flow Cytometry
• Use:
  Evaluation of patients who develop thrombocytopenia after exposure to certaindrugs is an important component of clinical evaluation.
• Clinical Significance:
  

  Following exposure to certain drugs, acute severe thrombocytopenia can occurdue to the formation of antibodies that react with platelets in the presence of drug. IgG and/or IgM antibodies induced by the following drugs have been detected:

  Abciximab (ReoPro™)* Carbamazepine Ceftazidime Ceftizoxime Ceftriaxone Eptifibatide (Integrelin™) Fentanyl Ibuprofen

  Loracarbef Naproxen GIc Orbofiban Phenytoin Propoxyphene Quinidine Quinine Ranitidine Rifampin

  Sulfamethoxazole Sulfisoxazole Suramin Tirofiban (Aggrastat™) Trimethoprim Vancomycin Xemilofiban

  Testing for other drugs is available.

  * For Abciximab (RePro™) Dependent Platelet Antibody order BloodCenter test code 5900, CPT 86022x12

  References:
  • McFarland JG. Laboratory Investigation of drug-induced immune thrombocytopenia. Transfus Med Rev 4:275-287, 1993.
  • Curtis BR, McFarland JG, Wu GG, Visentin GP, Aster RH. Antibodies in sulfonamide-induced thrombocytopenia recognize calcium-dependent epitopes on the glycoprotein IIb/IIIa complex. Blood 84:176-183, 1994.
  • Bednar B, et al. Drug-dependent antibodies against glycoprotein IIb/IIIa induce thrombocytopenia [abstract]. Circulation 94 (suppl. I):99, 1996.
  • Curtis BR, McFarland JG, Garrity MM, Aster RH. Thrombocytopenia induced by abciximab: studies of pathogenesis [abstract]. Blood (suppl. 1):92, 1998.
  • Gentilini G, Curtis BR, Aster RH. An antibody from a patient with ranitidine-induced thrombocytopenia recognizes a site on glycoprotein IX that is a favored target for drug-induced antibodies. Blood 92:2359-2365, 1998.
  • Joseph T, Marco J, Gregorin L. Acute profound thrombocytopenia after abciximab therapy during coronary angioplasty. Clin Card 21:851-852, 1998.
  • Brassard JA, Cooper RA, Kupfer SR, Komocsar WJ, Curtis BR, Kane MD, Aster RH. Acute Thrombocytopenia after treatment with the oral fibrinogen receptor antagonist xemilofiban: clinical presentation and evidence for an immune etiology [abstract]. Blood (suppl. 1):94, 1999.
  • Gawaz M, Neumann FJ, Schomig A. Evaluation of platelet membrane glycoproteins in coronary artery disease. Circulation 99:1-11, 1999.
  • Curtis BR, Swyers J, Divgi A, McFarland JG, Aster RH. Thrombocytopenia after second exposure to abciximab is caused by antibodies that recognize abciximab-coated platelets. Blood 99:2054-2059, 2002.
  • Von Drygalski A, Curtis BR, Bougie DW, Mcfarland JG, Ahl S, Limbu I, Baker KR, Aster RH. Vancomycin-induced immune thrombocytopenia. N Engl J Med 356:904-910, 2007.

• Reference Range:
  No drug-dependent platelet antibodies detected (Fluorescence Ratio ≤ 2.0)
• Additional Test Info:
  

  Flow cytometry is the most sensitive method available for detection of drug-dependent platelet antibodies. Patient serum is incubated with normal group O target platelets in both the presence and absence of drug and boundimmunoglobulin is detected. Fluorescence values obtained in the presence andabsence of drug are compared.

  Only serum or citrated plasma is accepted for testing. Positive test results are not absolutely diagnostic of drug-induced thrombocytopenia and must be used in combination with clinical information to make a diagnosis. Negative results do not completely rule out a diagnosis of drug-induced immune thrombocytopenia.

• Day Run:
  Varies; Twice each week
• Test Type:
  IMMUNOLOGY