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Abstract
Background: A practical guideline for detection and managements of some common infectious agents in cases with chronic ITP (Idiopathic Thrombocytopenic Purpura) is so important. Objectives: to investigate the role of H. pylori infection in children with chronic ITP in an endemic area. Materials and methods: A case control study done in pediatric ward Rasul Hospital, Tehran, Iran (2009-2010). 51 chronic ITP cases and 25 controls were assessed. H. pylori IgG & IgA ELISA (LDN -Germany) assesses in all cases and controls. All cases undergoing Bone Marrow Aspiration. H. pylori -PCR evaluated (QIAquickP® QIAGEN; Germany). P-value <0.05 was considered statistically significant. Results: cases were between 1- 20 years (mean 13.3.5 ± 7.6 y). Platelet count varied between 5000-1330000 (mean 63621 ± 37369.9) Positive H. pylori- IgA observed in 70% (36/51) of cases and 4% (1/25) of controls; p-value=0.00. H. pylori (IgG) was not significantly difference between cases and controls. [51% (26/51) vs. 32% (8/25), p-value=0.09] .Poor agreement observed between H. pylori –IgA and H. pylori - IgG antibodies and severity of thrombocytopenia in ITP cases (Kappa=-0.11; 0.04). Positive PCR results was % 5.9% (3/51) in ITP cases without significant difference in age between positive and negative PCR results (mean age 9.3 ± 9.7 years vs. 13.5 ± 7.52 years; p-value =0.3) Poor agreement between positive PCR and positivity of IgA (actual agreement=47.062%; p-value =0.5; Kappa=- 0.04), and IgG antibodies (actual agreement=40.91%; p-value =0.6; Kappa=- 0.04 respectively) were observed in ITP cases. Conclusion: We concluded that H. pylori infection (serologically) is high in young Iranian population. In chronic ITP, the H. pylori infection can be considered as an additional disorder which aggravates the main disease. The management of mild-to-moderate chronic ITP in Iranian patients, especially those with a recent onset of disease, should include an investigation for and eradication of infection with H. pylori.
Highlights
Idiopathic Thrombocytopenic Purpura (ITP) is defined as a characteristic rash associated with an abnormally low platelet count of unknown cause
Platelet count varied between 5000-1330000 Positive H. pylori- IgA observed in 70% (36/51) of cases and 4% (1/25) of controls; p-value=0.00
We concluded that H. pylori infection is high in young Iranian population
Summary
Idiopathic Thrombocytopenic Purpura (ITP) is defined as a characteristic rash associated with an abnormally low platelet count of unknown cause. In opinion of James and other authors Idiopathic Thrombocytopenic Purpura (ITP) defined as isolated thrombocytopenia with no clinically apparent associated conditions or other causes of thrombocytopenia. Scandellari et al showed a cross-reaction of an H. pylori urease B monoclonal antibody with platelet glycoprotein IIIa and suggested that the immune response to UreB may be involved in the pathogenesis of ITP [2]. Arnold et al showed an overall platelet response in more than 50% of the patients successfully treated for the infection and increased response rates in countries with a high prevalence of H. pylori infection in background populations, i.e. in patients with less severe degrees of thrombocytopenia and in those with shorter disease duration. A practical guideline for detection and managements of some common infectious agents in cases with chronic ITP (Idiopathic Thrombocytopenic Purpura) is so important
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