Abstract
BackgroundIdiopathic (immune) thrombocytopenic purpura (ITP) is an acquired disorder characterized by autoantibodies against platelet membrane antigens. Several studies found an association between Helicobacter Pylori infection and the incidence of ITP. So far, It is still unclear whether H. pylori eradication will increase platelet counts in adult ITP patients. We conduct this study to investigate platelet recovery in ITP patients after H. pylori eradication.MethodsThis is a prospective study. The diagnostic criterion for Idiopathic thrombocytopenic purpura is: isolated thrombocytopenia, with no evidence of any underlying causes like drugs, TTP, SLE, hepatitis, HIV,CLL and… etc. We examined blood smears of all patients. We have diagnosed Helicobacter pylori infection by histological examination of several biopsies obtained from stomach and duodenum by esophagogastroduodenoscopy (EGD). If EGD was not applicable due to patient’s poor situation or platelet count, H.pylori infection was diagnosed by the positivity of serum antibodies or respiratory urease test. We treated infected patients with triple therapy (omeprazole 40 mg once daily, amoxicillin 1000 mg twice daily and clarithromycin 500 mg twice daily) for 14 days. Uninfected patients did not receive any treatment. We did platelet quantification at the beginning of the study, at the end of the first month, at the end of the third month and at the end of the sixth month.ResultsThis study involved 50 patients with chronic ITP, 29 males (58%) and 21 females (42%). Participants ages range between18 and 51 years (mean age = 28.60 years). We diagnosed H. pylori in 36 patients (72%), who were treated with triple therapy. At the end of the sixth month, 10 of them (27.77%) showed complete response, and 18 of them (50%) showed partial response. The 14 uninfected patients, who did not receive any treatment, did not show neither complete nor partial response. Patient sex and age were not associated with achieving response, while baseline platelet count and H.pylori infection did.ConclusionHelicobacter pylori eradication significantly increases platelet counts in adult ITP patients.
Highlights
Idiopathic thrombocytopenic purpura (ITP) is an acquired disorder characterized by autoantibodies against platelet membrane antigens
Platelet counts in Hp− Patients ranged from 12 × 109/L to 42 × 109/L and the mean value was 25.21 × 109/L (SD = 8.469)
Independent sample T test shows that the mean platelet count of Hp − patients is significantly less than the mean platelet count of the Hp+ Patients (P (0.001)
Summary
Idiopathic (immune) thrombocytopenic purpura (ITP) is an acquired disorder characterized by autoantibodies against platelet membrane antigens. Several studies found an association between Helicobacter Pylori infection and the incidence of ITP. It is still unclear whether H. pylori eradication will increase platelet counts in adult ITP patients. We conduct this study to investigate platelet recovery in ITP patients after H. pylori eradication. Incidence rate of ITP is about 50–100 new cases per million per year, half of them are children. At least 70% of cases diagnosed in childhood will recover completely within six months, even without treatment [2, 3]. A third of the remaining chronic cases will completely recover during follow-up [4, 5], another third will end up with only mild thrombocytopenia (platelet count above 50 × 109/L) [6]
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