Cytopénies immunologiques

Abstract

Anaemias, thrombocytopenias and neutropenias can result from aggressions by auto, allo or drug dependant antibodies. Clinical features are often suggestive of the immune mechanism of cell destruction. According to the mechanism and the lineage involved. biological methods are more or less helpful for positive diagnosis. Added to classical direct and indirect antiglobulin tests the gel test offers a new practical approach to the immunological diagnosis of immune anaemia. This recent technology is currently under study in order to evaluate its actual relevance in diagnosis and characterisation of these pathologies. Due to its lack of specificity, the evaluation of platelet associated IgG has not proven helpful in diagnosis of autoimmune thrombocytopenias. The MAIPA test is more promising and seems to be more efficient in the study of different kind of immune thromnbocytopenias, but its complexity leads to restrict it to clinical cases in which a biological proof is essential. The very short survival of granulocytes in-vitro adds to the complexity of granulocyte immunology which is still reserved to highly specialised laboratories. However in cautiously selected cases immunological studies can be conclusive in the diagnosis of auto or alloimmune neutropenias. To day the study of drug dependant antibody remains still limited to clinical research.