EFFECT OF ERADICATION OF HELICOBACTER PYLORI INFECTION ON THE PLATELET COUNTS IN PATIENTS PRESENTING WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA
Background: Idiopathic thrombocytopenic purpura (ITP) is a rare autoimmune disease characterized by the platelet destruction that is autoantibody mediated, and there is suboptimal platelet production in the absence of a known cause, this leads to decreased peripheral blood platelet counts or thrombocytopenia and Helicobacter pylori has direct association with ITP. The aim of this study was to see the platelet recovery in patients of ITP after the H. pylori infection eradication. Methods: This was a case control study and 120 ITP patients who tested positive for H. pylori (divided into age and sex matched treatment and the control groups) were enrolled from the outdoor patients (OPD) of Sheikh Zayed Medical Complex. Stool antigen (HpSA) enzyme immunoassay method (EIA) method was used for H. pylori detection. Results: The response of the platelet count in the treatment group was a ‘complete response’ in 35 (60.3%) patients, a partial response in 16 (27.6%) patients and no response was found in 7 (12.1%) cases. However, no remarkable change was seen in the platelet counts of the patients in the control group. Conclusion: Complete eradication of H. pylori helps in the recovery of H. pylori induced platelet reduction and detection and eradication of H. pylori infection should be considered in the work-up of patients with ITP.
Keywords: Eradication therapy, H. pylori, Idiopathic Thrombocytopenic Purpura, Platelet counts Thrombocytopenia
Pak J Physiol 2017;13(2):41–3
2. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2012;115:168–86.
3. George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996;88:3–40.
4. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions, and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009;113:2386–93.
5. British Committee for Standards in Haematology: General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Hematol 2003;120:574–96.
6. Michel M, Cooper N, Jean C, Frissora C, Bussel JB. Do Helicobacter pylori initiate or perpetuate immune thrombocytopenic purpura? Blood 2003;103:890–6.
7. Franchini M, Veneri D. Helicobacter pylori infection and immune thrombocytopenic purpura: an update. Helicobacter 2004;9:342–6.
8. Inaba T, Mizuno M, Take S, Suwaki K, Honda T, Kawai K, et al. Eradication of Helicobacter pylori increases platelet count in patients with idiopathic thrombocytopenic purpura in Japan. Eur J Clin Invest 2005;35:214–9.
9. Emilia G, Luppi M, Zucchini P, Morselli M, Potenza L, Forghieri F, et al. Helicobacter pylori infection and chronic Immune Thrombocytopenic Purpura: long-term results of bacterium eradication and association with bacterium virulence profiles. Blood 2007;110:3833–41.
10. Lee M, Kemp J A, Canning A, Egan C, Tataronis G, Farraye FA. et al. A randomized controlled trial of an enhanced patient compliance program for Helicobacter pylori therapy. Arch Intern Med 1999;159:2312–16.
11. Kim JW, Kim JG, Chae SL, Cha YJ, Park SM, et al. High prevalence of multiple strain colonization of Helicobacter pylori in Korean patients: DNA diversity among clinical isolates from the gastric corpus antrum and duodenum. Korean J Intern Med 2004;19(1):1–9.
12. Sheikh KH, Ahmed S, Ayyub M, Anwar J. Association of Helicobacter pylori infection with idiopathic thrombocytopenic purpura. J Pak Med Assoc 2009;59:660–3.