On the mechanism of thrombocytopenic purpura in sexually active homosexual men.

Important note: Information in this article was accurate in 1984. The state of the art may have changed since the publication date.

On the mechanism of thrombocytopenic purpura in sexually active homosexual men.

N Engl J Med. 1984 Sep 6;311(10):635-9. Unique Identifier : AIDSLINE MED/84295403
Walsh CM; Nardi MA; Karpatkin S

Abstract: Thrombocytopenic purpura has recently been noted in sexually active homosexual men. To elucidate the pathogenesis of thrombocytopenic purpura in this population, we compared the disorder in 33 homosexual men with that in 23 patients (15 women and 8 men) thought to have classic autoimmune thrombocytopenic purpura. The homosexual group had 3.8-fold higher levels of platelet-bound IgG and 4.2-fold higher levels of platelet-bound complement than the patients with autoimmune thrombocytopenic purpura. Eluates from the platelets of only 1 of 10 homosexual patients reacted in vitro with normal platelets, as compared with those from the platelets of 12 of 15 patients with autoimmune thrombocytopenic purpura. Twenty-one of 24 homosexual patients (88 per cent) had elevated serum levels of immune complexes that were capable of binding to platelets, whereas none of 5 patients with autoimmune thrombocytopenic purpura had circulating immune complexes. The IgG fraction of positive serum samples from three homosexual patients did not bind to normal platelets, whereas that from the positive serum of two patients with autoimmune thrombocytopenic purpura and one woman in whom isoimmune antiplatelet antibody developed during pregnancy (studied as a positive control) did bind to normal platelets. We conclude that, whereas classic autoimmune thrombocytopenic purpura involves antiplatelet IgG directed against platelet antigenic determinants, the thrombocytopenic purpura that occurs in sexually active homosexual men is usually caused not by antiplatelet IgG but probably by the nonspecific deposition of complement and immune complexes on platelets.

Keywords: Acquired Immunodeficiency Syndrome/COMPLICATIONS Antigen-Antibody Complex/ANALYSIS Autoimmune Diseases/BLOOD/IMMUNOLOGY Blood Platelets/IMMUNOLOGY Complement/ANALYSIS Female *Homosexuality Human IgG/ANALYSIS/IMMUNOLOGY IgM/ANALYSIS Male Platelet Count Purpura, Thrombocytopenic/BLOOD/COMPLICATIONS/*IMMUNOLOGY Sex Behavior Support, U.S. Gov't, P.H.S. JOURNAL ARTICLE

841230
M84C0085

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