Idiopathic Thrombocytopenic Purpura Patients Research Articles

Reference guide for the treatment of adult idiopathic thrombocytopenic purpura

The treatment strategy of adult idiopathic thrombocytopenic purpura (ITP) in Japan had consisted of corticosteroids as the first-line option, splenectomy as the second-line option, and others as the third-line option, respectively, for a long time. However, thrombopoietin receptor agonists (TPO-RAs) have been widely adopted recently for corticosteroid-resistant ITP, and indications for rituximab have been extended to adult ITP in Japan, suggesting that ITP treatment is dramatically changing. In the "Reference guide for adult ITP treatments in Japan" revised in 2019, TPO-RAs and rituximab are equally recommended as second-line treatments alongside splenectomy. It is suggested to select from among the second-line treatments with careful consideration of not only their advantages and disadvantages but also aspects of the condition and situation of each patient such as any comorbidities or lifestyle factors. Moreover, since multiple effective therapeutic options are now available as second-line options, it is preferable to consider an early transition to second-line treatments for corticosteroid-refractory/dependent ITP patients.

Effects of Recombinant Human Thrombopoietin on Funtion of T and B Lymphocyte in Prieary ITP Patients

To study the changes of Th1 and Th2 type cytokines and B lymphocyte level and their clinical significance in idiopathic thrombocytopenic purpura (ITP) patients treated by recombinant human thrombopoietin (rhTPO). The peripheral blood levels of Th1 and Th2 type of cytokines and B lymphocyte were estimated by CBA in 48 patients with ITP, and compared with those in 35 control persons of heath examination. Before treatment, the levels of Th1 type cytokines and B lymphocyte in 48 patients with ITP were higher, and the levels of Th2 type cytokines were lower than those of healthy controls (P＜0.05). The levels of the peripheral blood CD19+ cells, CD5+CD19+ cells, IL-2 expression negatively correlated with Plt counts in ITP patients (P＜0.05), the levels of IL-4 positively correlated with Plt counts (P＜0.05). After treatment with rhTPO, the levels of Th1 type cytokines and B lymphocytes in 48 patients with ITP significantly decreased, and the levels of Th2 type cytokines significantly increased in comparison with those before treatment (P＜0.05). Peripheral blood Th1 and Th2 type cytokines express abnormally and level of B lymphocytes increases significantly in ITP patinets. The disease severity correlats with the levels of Th1 and Th2 type cytokines and B lymphocytes. Platelets increase after rhTPO treatment, showing that rhTPO can play an important role in regulating Th1 and Th2 immunologic balance and B lymphocyte level in ITP patients.

P3603Impact of idiopathic thrombocytopenic purpura on clinical outcomes in patients with acute myocardial infarction

Abstract Background There is scarce evidence reflecting the clinical outcomes in patients with Idiopathic Thrombocytopenic Purpura (ITP) and Acute Myocardial Infarction (AMI). The ITP patient population is at higher risk of bleeding complications due to low platelet counts and difficulty in managing their antiplatelet and anticoagulation therapy. In our study, we sought to assess clinical outcomes of ITP patients admitted with AMI using the US national inpatient sample (NIS) database. Purpose To determine difference in in-hospital mortality, clinical complications, and length of stay (LOS) in AMI patients with and without ITP. Methods We identified adults aged ≥18 years hospitalized from 2005 to 2014 with AMI as their primary diagnosis utilizing ICD-9 codes 410.0 to 410.92. Patients with ITP were identified using ICD-9 code 287.31. The primary outcome was in-hospital mortality. Secondary outcomes included coronary revascularization procedures (PCI and CABG), and in-hospital complications including bleeding (intracranial, epistaxis, GI, and GU bleeding, hematoma, and bleeding requiring transfusion), cardiac complications, transfusions, acute ischemic stroke (AIS), and LOS. A propensity-matched cohort accounting for demographic characteristics, comorbidities, and cardiovascular risk factors, was created to compare these outcomes. Patients with secondary causes of ITP such as HIV, pregnancy, sepsis, SLE, malignancy were excluded. Results A total of 1108034 AMI admissions, of which 1002 with ITP, were identified. In the unmatched group, patients with ITP were older, and had more comorbidities (diabetes mellitus; hypothyroidism; atrial fibrillation; previous history of cardiovascular, peripheral, and end stage renal disease; all p<0.05). In the AMI population, 851 ITP and 851 non-ITP admissions were propensity-matched. Figure 1 illustrates the primary and secondary outcomes of the study among the propensity-matched study groups. Although there was no difference in short-term mortality between the ITP and non-ITP patients with AMI, patients with ITP were less likely to undergo coronary revascularization possibly because of thrombocytopenia. Patients with ITP had significantly more bleeding complications and transfusions. We observed in our study that patients with ITP had a significantly longer LOS compared to non-ITP patients (6.1 vs 5.4 days, with a mean ratio of 1.14 (95% CI: 1.05,1.23)). Conclusion In the large population of patients included in the NIS database, patients with ITP admitted with AMI, have a significantly higher rate of bleeding complications, undergo less PCI and have a longer LOS compared to AMI patients without ITP. There are no current guidelines by ACC/AHA/ESC regarding management of patients with AMI and thrombocytopenia. These results warrant further investigation through randomized controlled trials including patients with thrombocytopenia to assess long term outcomes and to define optimal management in this population.

The clinical effect of Prednisone in combination with Mycophenolate mofetil on idiopathic thrombocytopenic purpura (ITP) and its influence on the level of peripheral blood T lymphocytes and NK lymphocytes.

ObjectiveTo explore he curative effect and safety of Prednisone in combination with Mycophenolate in treating ITP and its influence on the level of peripheral blood T lymphocytes and NK lymphocytes.Method93 cases of ITP patients were divided into the observation group and the control group by the Random Number Table method, 48 cases for the observation group, 45 for another. Patients in the control group orally took 0.5 mg/kg Prednisone Acetate tablets daily, two times each in the morning and evening. And the observation group, based on the treatment of the control group, orally took Mycophenolate Mofetil Dispersible tablets twice a day, 1 g each time. According to patients’ conditions, 3 to 5 courses were set for treatment with 3 weeks a course. Compared PLT amount and the changing situation of inflammatory factors, CD3+ and CD3+CD95L+ before and after the treatment, the level of CD3+Caspase-3+ and CD3+Caspase-8+, NK+, NK+ CD95L+, NK+Caspase-3+, NK+Caspase-8, the curative effect and adverse events.ResultAfter treatment, PLT amount in both groups increased, and the increase in the observation group was much higher than that of the control group, the difference had statistical significance (P < 0.05). The time needed for PLT amount in the control group to reach the normal and peak values was longer than that of the observation group, whose PLT peak value was higher than another group. The difference had statistical significance (P < 0.05). After the treatment, the levels of TNF-α and IL-6 were lowered, and the value of the observation group was lower than that of another. The difference between and within the group has statistical significance. After the treatment, the level of CD3+, CD3+CD95L+ and CD3+Caspase-8+ is much higher and CD3+Caspase-3+ level lower than that before the treatment. The difference has statistical significance (P < 0.05). After the treatment, the level of NK+ and NK+ CD95L+ is higher and the level of NK+Caspase-8+ lower than that before the treatment. The difference has statistical significance (P < 0.05). After the treatment, the total effective rate 91.67% of the observation group is much higher than that 75.56% of another. The difference has statistical significance (P < 0.05). After the treatment, the incidence rate of adverse events in the control group is 11.11% (5/45), while 4.17% (2/48) in the observation group. The difference between groups has statistical significance (χ2 = 3.890, P < 0.05).ConclusionThe curative effect of Prednisone in combination with Mycophenolate on ITP patients is better than orally taking Prednisone tablets. Moreover, when it comes to Prednisone in combination with Mycophenolate, both the PLT amount and immunocompetence are improved without much adverse reaction, and the molecules of peripheral blood T lymphocytes and NK lymphocytes can be effectively adjusted to relieve the symptoms. So the method is trustworthy to be popularized for clinical practices.

Helicobacter pylori: An Underrated Cause of Immune Thrombocytopenic Purpura. A Comprehensive Review.

Idiopathic thrombocytopenic purpura (ITP) is the autoimmune-mediated destruction of platelets. ITP is a diagnosis of exclusion after other identifiable etiologies have been ruled out. After the first report by Gasbarrini et al. (1998) showing rising platelet counts in ITP patients following Helicobacter pylori (HP) eradication therapy, there is growing evidence that highlights the role of HP in triggering ITP. However, the exact pathophysiology of HP-associated ITP is still unclear, but many theories have been implicated in this regard. According to various reports, the postulated mechanisms for the role of HP in cITP include molecular mimicry, increased plasmacytoid dendritic cell numbers, phagocytic perturbation, and variable host immune response to HP virulence factors. One famous theory suggested molecular mimicry between platelet surface antigen and bacterial virulence factor, i.e. cytotoxin-associated gene A (CagA). It is thought that a chronic inflammatory response following an HP infection induces the host autoantibodies' response against CagA, which cross-reacts with platelet surface glycoproteins; therefore, it may accelerate platelet destruction in the host reticuloendothelial system. However, further studies are mandated to better understand the causal link between ITP and HP and study the role of biogeography. Nowadays, it is recommended that every patient with ITP should undergo HP diagnostic testing and triple therapy should be administered in all those candidates who test positive for HP infection. In our review, there were a few pregnant female ITP patients who took HP eradication therapy mainly after 20 weeks of gestation without maternal or fetal worst outcomes. However, large-scale studies are advisable to study the adverse fetal outcomes following triple therapy use.

Thrombocytopenia and Coronary Artery Disease, the Existing Dilemmas

Abstract Background: Platelets play a pivotal role in the pathogenesis of acute coronary syndrome (ACS) and acute or chronic complications following percutaneous coronary intervention (PCI) as well. Platelet inhibition is a cornerstone treatment in the management of these patients. Thrombocytopenia in patients with ACS is uncommon. Idiopathic thrombocytopenic purpura (ITP) is a rare phenomenon; nevertheless, some case series presenting concomitant ACS and ITP have been described in the literature. The safety of antiplatelet therapy and PCI in patients who have ACS and thrombocytopenia is limited. Case summary: We present a case of a 60-year-old patient with ITP who was admitted with unstable angina pectoris. On admission, the platelet count was 23 × 109/L. Coronary CT angiography revealed severe stenosis in the mid portion of RCA. After one-week treatment with high-dose Prednisolone, the platelet count recovered, and coronary catheterization was performed. Successful PCI to the RCA with drug-eluting stent was performed. The patient was discharged on dual antiplatelet therapy. Conclusion: The case suggests that PCI is a suitable treatment for ITP patients with ACS. Hemostasis is the major concern in managing these patients. The treatment strategy may be based on platelet function rather than platelet count alone. Further analysis of antiplatelet therapies as mono or dual therapy are needed.

Predictive Value of Risk Factors for Chronic Idiopathic Thrombocytopenic Purpura in Patients with Acute Type of Disease

Background: Immune thrombocytopenic purpura (ITP) is an autoimmune disease in which autoantibodies react with platelet surface antigens and results in mild to severe thrombocytopenia due to decreased platelet count or inhibition of platelet production. Given the relatively high prevalence of ITP among children and the lack of standard diagnostic testing for the diagnosis of chronic disease, this study evaluated the predictive value of risk factors for chronic ITP in hospitalized patients. Methods: This prospective cohort study was performed on 65 children with ITP who referred to Ali Asghar and Rasool Akram hospitals in Tehran, Iran during the years 2017 and 2018. Relationships between different risk factors including age of diagnosis, gender, white cell count, primary platelet count, Mean platelet volume (MPV) , history and type of previous patient infection, FCG gene mutation, and type of FCG mutation with chronic disease incidence were investigated using multiple logistic regression model. Results: Of 65 patients, 31 (47.69%) were male and 34 (52.31%) were included in the study. 28 patients (43.08%) had acute ITP and 37 (56.92%) had chronic ITP. Frequency of FCG gene mutation in patients with chronic and acute type ITP was 16.36% and 7.27%, respectively (p = 0.51). No association was found between the history of previous infection and its type with the chronic incidence of ITP. Multiple Logistic regression model showed that 3 factors including absolute number of lymphocytes, age of diagnosis and primary WBC count were directly linked to chronic ITP. Furthermore, 3 factors of platelet, sex and MPV were indirectly related to chronic ITP. In addition, absolute number of lymphocytes, age of diagnosis and primary WBC count were significantly associated with chronic ITP. The ROC analysis showed that the cut off rate of these factors was 0.31. Further analysis of these risk factors in comparison with the gold standard demonstrated that the diagnostic sensitivity and specificity of these risk factors for chronic ITP were 73.08% and their specificity was 88.57%, indicating the high importance and predictive power of these risk factors. Conclusion: According to the results of the current study, evaluation of 6 major risk factors including absolute lymphocyte count, age at diagnosis, sex, MPV level, platelet level at diagnosis and primary WBC count for the identification of chronic ITP is recommended before IVIG treatment. Of course, more comprehensive studies can definitely lead to more comprehensive models. Funding Statement: The authors stated: Not applicable. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The children participated in the study with the full parental consent, ensuring that all children's information was kept confidential. The project was initially approved by the Ethics Committee of Iran University of Medical Sciences with code IR.IUMS.FDM.REC. 1396.29265

Regulatory T cell CD4 ‏&CD25‏ expression and chemokine C-X-C ligand 13 level before and after corticosteroid therapy in pediatric ITP patients

Childhood Idiopathic thrombocytopenic purpura (ITP) is one of the most commons autoimmune bleeding disorders characterized by isolated, immune-mediated low platelet count, the T-follicular helper (Tfh) cells are a subset of effector CD4 (+) T cells, that plays a pivotal role in maintaining self-tolerance, deregulation of Tfh activities has a key role in immune process taking place in ITP in which the production of platelet autoantibodies might be caused by cytokine network dysregulation. The objective of our study was to analyze the relationship of Tfh cells CD4&CD25 and C-X-C ligand 13 (CXCL13) expressions before and after steroid thereby in pediatric ITP. Material and method: the study included 45 pediatric patients with acute ITP and 20 healthy controls; we used flowcytometry to assess percentages of CD4‏ and CD25‏ cells as markers of regulatory T cells, also, the serum level of interleukin- CXCL13 was measured by ELISA at diagnosis and after 4 weeks receiving corticosteroid. Results: the expression of CD4‏ & CD25‏ ‏ markers were significantly reduced in ITP cases, who also showed an elevated CXCL13 level in comparison to controls, however, the level of CXCL13 declined after treatment, the CXCL13 optimum cut off point for predicting ITP response to therapy was determined to be 90 pg/ml with AUC 0.976, Sensitivity 88.89% and Specificity 100% P-value < 0.00. Conclusion: Serum CXCL-13 levels could be used as a significant predictor of response to therapy in ITP patients, CD4&‏CD25 expression has a role in the pathogenesis of childhood acute ITP principally linked to the level of platelet count drop.

A case report: Undiagnosed idiopathic thrombocytopenic purpura (ITP) patient presenting with a post-partum haemorrhage

Introduction: Post-partum haemorrhage (PPH) is a life threatening condition which could occur due to uterine atony, retained products, trauma or a coagulation defect. Among the coagulation defect which occur due to thrombocytopenia, ITP occurs in one or two of every 1000 pregnancies. ITP is usually diagnosed before conception and treated with steroids to minimize its detrimental effects during labour. However, if it is not controlled, the reduced platelets can result in PPH.

Therapeutic effects of rituximab combined with cyclophosphamide on refractory idiopathic thrombocytopenic purpura.

Therapeutic effects of rituximab combined with cyclophosphamide on refractory idiopathic thrombocytopenic purpura (ITP) were investigated. We retrospectively analyzed 249 patients with refractory ITP who were admitted to Qingdao Hiser Medical Group between March 2013 and March 2017. Curative effects of patients treated with rituximab, cyclophosphamide, and combination therapy were observed and the changes of platelet count, PA IgG, and lymphocyte CD20 before and after treatment, as well as the incidence of adverse reactions after treatment, were compared. There was no significant difference in the expression of lymphocyte CD20, PA IgG and platelet count among the three groups of refractory ITP patients before treatment (P>0.05). After treatment, the expression levels of CD20 and PA IgG in lymphocytes were significantly downregulated, and platelet counts significantly increased in the three groups (P<0.05). After treatment, CD20 and PA IgG levels in combined therapy group were significantly lower, and platelet count was significantly higher, than those in the rituximab and cyclophosphamide groups (P<0.05). Also, after rituximab treatment, the expression levels of CD20 and PA IgG in lymphocytes were significantly lower than those in cyclophosphamide group (P<0.05), and platelet count was higher than that in cyclophosphamide group (P<0.05). After treatment, the total effective rate in combined therapy group was higher than that in the rituximab and cyclophosphamide group (P<0.05). Total effective rate of rituximab group was significantly higher than that of cyclophosphamide group (P<0.05). The incidence of adverse reactions in combined therapy group was 14.29% (12/84), which was significantly lower than that in cyclophosphamide group (40.70%, 35/86, P<0.05) and rituximab group (29.11%, 23/79, P<0.05). The application of rituximab combined with cyclophosphamide in the treatment of refractory ITP can improve patients clinical symptoms. The efficacy of this technique is promising with no serious adverse reactions. This technique should be popularized in clinical practice.

Short-term efficacy and safety of rhTPO combined with traditional monotherapy regimen for the treatment of ITP: a Meta-analysis

Objective To evaluate the short-term efficacy and safety of recombinant human thrombopoietin(rhTPO) combined with glucocorticoid or danazol regimen and traditional monotherapy regimen in the treatment of idiopathic thrombocytopenic purpura(ITP). Methods All the randomized controlled trial(RCT) about short-term efficacy and safety of combined rhTPO regimen with hormone or danazol regimen and traditional monotherapy regimen in the treatment of ITP were electronically collected by searching databases, including PubMed, Wanfang database, VIP database, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc(CBMdisc). Retrieval time is up to September 2017.Independent search of the literature by two trained researchers, excluding articles that were not available and of non-compliant quality, and using the Jadad scale for literature quality scoring.Then, Meta-analysis of the efficacy and safety of rhTPO combined with traditional glucocorticoids or danazol and traditional monotherapy regimenin the treatment of ITP were preformed by using R software. Results A total of 10 RCTs involving 625 ITP patients were included by tracking the literatures and follow-up to relevant references with full text. Among them, there were 319 patients in the experimental group and 306 patients in the control group. Ten RCTs in 10 articles have lower Jadad scores which are low quality RCTs. The Meta-analysis of the short-term efficacy and adverse effects of 10 studies on ITP in the study were as follows. ①Comparison of significant efficiency rate: 7 RCTs of 420 ITP patients from 7 studies were found to have relatively high heterogeneity (I2=62.3%, P=0.01). There was significant difference in significant efficiency rate between experimental group and the control group by the random effects model of Meta-analysis(OR=2.95, 95% CI: 1.37-6.37, P=0.06). After removing factor of high-dose dexamethasone interference, 5 RCTs involving 287 ITP patients had mild heterogeneity (I2=45%, P=0.12), and Meta-analysis using a fixed-effect model showed that the significant efficiency rate of the experimental group was higher than that of the control group, and the difference was statistically significant (OR=5.28, 95% CI: 2.95-9.44, P<0.000 1). ②Comparison of good efficiency rate: Six RCTs involving 358 patients with ITP had mild heterogeneity (I2=38%, P=0.15). Meta-analysis showed that there was no statistically significant difference in good efficiency rate between the experimental group and the control group by the fixed-effect model(OR=1.30, 95%CI: 0.82-2.07, P=0.27). ③Comparison of total effective rate: The heterogeneity between the 9 RCTs included in the 563 patients with ITP was low (I2=0%, P=0.65). The Meta-analysis using the fixed-effect model showed that the total effective rate of the test group was higher than that of the control group (OR=3.79, 95% CI: 2.50-5.73, P<0.01). ④Comparison of incidence of adverse reactions showed there was no significant difference in the incidence of adverse reactions between the experimental group and the control group (OR=3.56, 95% CI: 0.85-14.95, P=0.08) among 4 RCTs. Conclusions Compared with traditional monotherapy regimen, rhTPO combined with glucocorticoid or danazol regimen can improve significant efficiency rate and the total effective rate of ITP patients, but there were no significant differences in good efficiency rate and incidence of adverse reaction. Key words: Thrombocytopenia; Thrombopoietin; Glucocorticoids; Danazol; Meta-analysis

Idiopathic Thrombocytopenic Purpura in Patients with Ischaemic Heart Disease - A Therapeutic Challenge

Idiopathic thrombocytopenic purpura (ITP) and myocardial infarction (MI) in an individual patient is a rare combination. MI mandates thrombolytic and antiplatelet therapy which increases the risk of bleeding in ITP. So far, no guideline deals with management protocol for ischaemic heart disease (IHD) in ITP patients. Here, we describe 2 cases of IHD who developed ITP while on antiplatelet therapy.Bangladesh Heart Journal 2018; 33(1) : 74-77

Characteristics of functional somatic syndromes and bodily distress syndrome in the general Danish population–The DanFunD study

Childhood Idiopathic thrombocytopenic purpura (ITP) is one of the most commons autoimmune bleeding disorders characterized by isolated, immune-mediated low platelet count, the T-follicular helper (Tfh) cells are a subset of effector CD4 (+) T cells, that plays a pivotal role in maintaining self-tolerance, deregulation of Tfh activities has a key role in immune process taking place in ITP in which the production of platelet autoantibodies might be caused by cytokine network dysregulation. The objective of our study was to analyze the relationship of Tfh cells CD4&CD25 and C-X-C ligand 13 (CXCL13) expressions before and after steroid thereby in pediatric ITP. Material and method: the study included 45 pediatric patients with acute ITP and 20 healthy controls; we used flowcytometry to assess percentages of CD4‏ and CD25‏ cells as markers of regulatory T cells, also, the serum level of interleukin- CXCL13 was measured by ELISA at diagnosis and after 4 weeks receiving corticosteroid. Results: the expression of CD4‏ & CD25‏ ‏ markers were significantly reduced in ITP cases, who also showed an elevated CXCL13 level in comparison to controls, however, the level of CXCL13 declined after treatment, the CXCL13 optimum cut off point for predicting ITP response to therapy was determined to be 90 pg/ml with AUC 0.976, Sensitivity 88.89% and Specificity 100% P-value < 0.00. Conclusion: Serum CXCL-13 levels could be used as a significant predictor of response to therapy in ITP patients, CD4&‏CD25 expression has a role in the pathogenesis of childhood acute ITP principally linked to the level of platelet count drop.

Analysis of Differentially Expressed Genes and the Interaction Network between Acute and Chronic Idiopathic Thrombocytopenic Purpura in Children

Objective To analyze the differentially expressed genes and key proteins in T cells between acute and chronic idiopathic thrombocytopenic purpura (ITP) in children and provide the basis for the prevention and therapies of this disease. Methods Microarray gene chip data from T cells of children with acute or chronic ITP were downloaded from the GEO Database. The gene expression profiles,gene function,and protein interaction network were analyzed by R,QOE,Networkanalyst,GCBI,and GenClip. Results The gene expression profiles between these two groups were significantly different. Among the 54 675 genes analyzed,there were 457 (0.84%) differentially expressed genes between these two groups. In the protein interaction networks among top 20 differentially expressed genes,the core was JUN(down-regulated) and ITCH(up-regulated),which were both related to the tumor necrosis factor signaling pathway;differentially expressed genes were mainly related to the activation and tolerance of T cell. Conclusions The gene expression profiles differ between acute and chronic ITP patients,suggesting that the gene transcription profile plays a regulatory role in the different stages of ITP. JUN and ITCH may play a role in predict the progression of ITP and may exert their biological functions by regulating the tumor necrosis factor signaling pathway.

The association between idiopathic thrombocytopenic purpura and cardiovascular disease: a retrospective cohort study

Background Idiopathic thrombocytopenic purpura (ITP) is classically characterized by a transient or persistent decrease of platelet count. Mortality is higher in the ITP population than the general population, with a possible association with increased cardiovascular disease (CVD). Objectives The objective was to assess the strength of the association between ITP and CVD, with a secondary aim to assess the impact of splenectomy on CVD. Methods A population-based retrospective, open cohort study using clinical codes was performed using data from 6591 patients with ITP and 24 275 randomly matched controls (up to 1:4 ratio matched by age, sex, body mass index and smoking status). The main outcome was the risk of CVD, which included ischemic heart disease, stroke, trans-ischemic attack and heart failure. Adjusted incidence rate ratios were calculated using Poisson regression. Results During a median 6-year observation period there was a CVD diagnosis recorded in 392 (5.9%) ITP patients and 1114 (4.5%) control patients. There was an increased risk of developing CVD in the ITP cohort (incidence rate ratio [IRR], 1.38; 95% confidence interval [CI], 1.23-1.55), which remained robust even after a sensitivity analysis only including incident cases of ITP. Findings suggested that patients who had undergone splenectomy were at even further increased risk of developing CVD when compared with the ITP population who had not undergone splenectomy (adjusted IRR, 1.69; 95% CI, 1.22-2.34). Conclusion There is an increased risk of developing CVD in patients with ITP and even further increased risk for those patients with ITP who underwent splenectomy.

Effect of rhIL-11 on Th1/Th2 and T-bet/GATA-3 imbalance in idiopathic thrombocytopenic purpura

Objective To investigate the effect of recombinant human interleukin 11 (rhlL-11) in the treatment of idiopathic thrombocytopenic purpura (ITP) on the levels of Th1, Th2 and the expression of their transcription factors T-bet mRNA, GATA-3 mRNA. Methods Fifty-six cases adult ITP patients hospitalized in the department of hematology of the Second People’s Hospital of Datong from May 2015 to December 2016 were collected, including 21 males and 35 females, aged 29~73 years; 10 healthy people in the same period were enrolled as control group, 4 males and 6 females, aged 20~52 years.Th1 and Th2 cell ratio and Th1/Th2 ratio of ITP patients were detected by flow cytometry before and after treatment.The expression levels of transcription factor T-bet and GATA-3 were measured using real-time fluorescence quantitative reverse transcription polymerase chain reaction (RT-PCR) before and after treatment. Results The effective rate of rhlL-11 in ITP treatment was 76.8%(43/56). For the effective patients, the median PLT after treatment increased (25.0 (15.0, 36.0)×109/L vs.68.0 (49.0, 108.0)×109/L, Z=-5.712, P 0.05). Conclusion rhIL-11 can effectively correct the imbalance in Th1 and Th2 cells and the imbalance of T-bet and GATA-3 in ITP patients, but it has no obvious therapeutic effect on a small number of patients Key words: Idiopathic thrombocytopenic purpura; Recombinant human interleukin-1; T Helper cells 1; T helper cells 2; T-box expressed in T Cells; GATA binding protein 3

Association between gene polymorphisms and clinical features in idiopathic thrombocytopenic purpura patients.

: Immune thrombocytopenic purpura (ITP) is an autoimmune disease in which increased platelet destruction and thrombocytopenia are diagnostic features. In fact, the exact pathogenesis of this disease is still unknown, but genetic changes can be a potential factor in the development of ITP. In this study, the relationship between polymorphisms with platelet destruction has been studied, which leads to decreased platelet count. Relevant literature was identified by a PubMed search (2000-2016) of English language papers using the terms 'ITP', 'polymorphism,' and 'immune system'. The majority of genetic changes (polymorphisms) occur in immune system genes, including interferon (IFN)-γ gene. These changes lead to the dysfunction of immune system and production of pathogenic antibodies against platelet surface glycoproteins such as glycoprotein IIb/IIIa, which eventually result in the destruction of platelets and increasing disease severity. In addition, IFN-γ as well as factors and cytokines involved in megakaryopoiesis, including stem cell factor and interleukin-3 (IL-3), leads to the differentiation of megakaryocytes and platelet release. Considering the fact that IFN-γ is a factor of inflammation and thrombocytopenia, coexistence of this cytokine with thrombopoietin, stem cell factor, and IL-3 results in megakaryocytes differentiation and platelet production, which can be effective to reduce disease severity and increase the platelet counts.

Platelet count response to Helicobacter pylori eradication for idiopathic thrombocytopenic purpura in northeastern Brazil.

BackgroundSeveral studies have demonstrated that platelet counts in Helicobacter pylori-positive patients with chronic idiopathic thrombocytopenic purpura improved significantly after successful eradication of the infection. However, depending of the geographical region of the study the results have been highly divergent.ObjectiveThe purpose of this study was to evaluate the effect of H. pylori eradication therapy on platelet count in a cohort of chronic idiopathic thrombocytopenic purpura patients from northeastern Brazil.MethodH. pylori status was determined in 28 chronic idiopathic thrombocytopenic purpura patients using the rapid urease test and histology. H. pylori-positive patients received standard triple therapy for one week. The effect of the eradication therapy was evaluated using the 13C-urea breath test two to three months after treatment.ResultsThe prevalence of H. pylori infection was similar to that found in the general population. Twenty-two patients (78.5%) were H. pylori-positive. Fifteen were treated, 13 (86%) of whom successfully. At six months, 4/13 (30%) displayed increased platelet counts, which remained throughout follow-up (12 months). Platelet response was not associated to mean baseline platelet count, duration of chronic idiopathic thrombocytopenic purpura, gender, age, previous use of medication, or splenectomy.ConclusionsH. pylori eradication therapy showed relatively low platelet recovery rates, comparable with previous studies from southeastern Brazil. The effect of H. pylori eradication on platelet counts remained after one year of follow-up suggesting that treating H. pylori infection might be worthwhile in a subset of chronic idiopathic thrombocytopenic purpura patients.

Zika virus and autoimmunity. One-step forward.

Zika virus (ZIKV) infection has been associated with the development of Guillain-Barré syndrome (GBS) and idiopathic thrombocytopenic purpura (ITP). Whether ZIKV infection is related to other autoimmune diseases is unknown. Therefore, an association study to evaluate rheumatic and thyroid autoimmunity in patients with ZIKV disease was conducted through a panel of 14 autoantibodies. In addition, a literature review on ZIKV, and GBS and ITP was performed. Our results disclosed a lack of association of rheumatoid and thyroid autoimmunity with ZIKV disease. A total of 272 cases of GBS related to ZIKV were retrieved from the literature, the majority of them being males (54.8%). Electrophysiological findings indicated acute inflammatory demyelinating polyneuropathy as the most frequent subphenotype (75.7%). Up to date, twenty-four cases of ITP in patients with ZIKV disease have been published. Although a few fatal cases have been observed, most of the reported patients responded well to immunomodulatory treatment. A review of the mechanisms incriminated into the development of autoimmune phenomenon in ZIKV disease indicates molecular mimicry as the most plausible one. Nevertheless, more research aimed at deciphering ZIKV disease pathogenesis and its relationship with autoimmunity is warranted.

The Role of IL-23 in Patients with Idiopathic Thrombocytopenic Purpura

Idiopathic thrombocytopenic purpura (ITP)is a bleeding disorder with an unclear etiology ,The most common hemorrhagic autoimmune disease, and characterized by isolated thrombocytopenia that is not accompanied by any other disorders that may lead to thrombocytopenia. Interleukin-23 (IL-23) is a member of the IL-12 family; it is primarily secreted by activated dendritic cells, Monocytes, and macrophages and has important implication in the pathogenesis of many autoimmune diseases. The aims of this study was to evaluate the role of IL-23 in diagnosis of idiopathic thrombocytopenic purpura. A total of 5 papers were obtained using the mentioned keywords in the research of all internet-based databases. The total number of cases in all of the studies was 239 cases. The mean age was recorded in 5 papers, and the mean age of each of them was 32.8 years. There are different method of detection of IL23 in different studies such as PCR, ELISA and flow cytometry These findings suggest that levels of IL-23 are significantly higher in ITP patients.