An Unusual Cause of Secondary ITP in a 34-Year-Old Hispanic Male

Secondary immune thrombocytopenic purpura (ITP) associated with Helicobacter pylori (H. pylori) infection has been described in the literature. It appears to have a geographic distribution; mostly encountered in countries with a higher prevalence for H. pylori such as Italy or Japan. H. pylori eradication has been recommended in the management of ITP with studies showing improvement in the platelet count in some patients. Substantial platelet count increases in patients with severe thrombocytopenia (platelet counts <30 × 103 microliter), however, are uncommon with H. pylori treatment alone. Here, we present a 34-year-old Hispanic male with worsening chronic thrombocytopenia that resolved following eradication of his H. pylori infection. Herein, we highlight a rare and reversible cause of secondary ITP. With this case report, we hope to encourage physicians to include H. pylori testing in the evaluation of thrombocytopenia.

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Correlation between Helicobacter Pylori Eradication and Platelet Count in Immune Thrombocytopenic Purpura (ITP).

Blood ◽

10.1182/blood.v106.11.4003.4003 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4003-4003 ◽

Cited By ~ 2

Author(s):

Jun Ho Jang ◽

Hyeoung Il Kim ◽

Hyun Woo Lee ◽

Seok Yun Kang ◽

Joon Seong Park ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Systemic Disease ◽

Eradication Therapy ◽

Thrombocytopenic Purpura ◽

Duodenal Ulcers ◽

Autoimmune Thyroid ◽

Platelet Counts ◽

H Pylori

Abstract BACKGROUND: Helicobacter pylori has clearly been implicated in the pathogenesis of gastric and duodenal ulcers, gastritis, and gastric malignancy. Remarkably, eradication of H. pylori from the gastric mucosa has been associated with improvement of systemic disease, including Sjögren’s syndrome, rheumatoid arthritis, autoimmune thyroid disease, and immune thrombocytopenic purpura (ITP). PURPOSE: To investigate the relationship between Helicobacter pylori infection and the clinical features of idiopathic thrombocytopenic purpura (ITP), and to examine the effects of H. pylori eradication on platelet counts. METHOD: A 13C urea breath test (UBT) for H. pylori infection was performed in a 25 consecutive patients with ITP at Ajou University School of Medicine, Suwon, Korea. Patients who tested positive for H. pylori received standard eradication therapy if their platelet count was < 50 x 109/L. RESULTS: H. pylori infection was detected in 18 patients (72%) and eradication therapy was successfully administered to all infected patients. H. pylori infection was not associated with dyspepsia or other clinical or laboratory features. Platelet responses were observed in 6 (33%) of these patients, which lasted for more than 4 months in 4 patients. Platelet associated antibody and anti platelet antibody were negative to all patients. CONCLUSION: H. pylori eradication may improve the platelet counts in some of adults (33%) in whom the ITP is of recent onset.

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Impact of Helicobacter pylori Eradication Therapy on Platelet Counts in Patients With Chronic Idiopathic Thrombocytopenic Purpura

Global Journal of Health Science ◽

10.5539/gjhs.v8n7p35 ◽

2015 ◽

Vol 8 (7) ◽

pp. 35 ◽

Cited By ~ 2

Author(s):

Mohamadreza Amiri

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Eradication Therapy ◽

Current Treatment ◽

Thrombocytopenic Purpura ◽

Stool Antigen Test ◽

Platelet Counts ◽

Before And After ◽

History Of ◽

H Pylori

This study was a before and after clinical evaluation of Helicobacter pylori eradication on platelet counts in a group of 23 patients with chronic Idiopathic (Autoimmune) thrombocytopenic purpura (CITP). H. pylori infection was identified in patients by a 13C-urea breath test and confirmed by an H. pylori stool antigen test. Eradication was conducted in patients testing positive. Infected (n = 10) and uninfected (n = 13) patient groups did not differ with respect to age, gender, history of previous splenectomy, treatment with anti-D, current treatment with corticosteroids, or initial platelet counts. H pylori eradication was successful in eight infected CITP patients, with two patients not responsive to treatment. Compared to the uninfected group, patients in the infected group who responded to eradication therapy had significantly increased platelet counts after six months (56.2 ± 22.2 vs. 233 ± 85.6 ×103 million cells/L; P < 0.01), whereas platelet counts in the non-responding patients and uninfected group did not differ after this period of time. H. pylori eradication promotes significant platelet count improvement in patients with CITP. Thus, all patients with CITP should be tested and treated for H. pylori infections.

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PLATELET COUNT RESPONSE TO HELICOBACTER PYLORI ERADICATION IN IRANIAN ‎PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC ‎PURPURA

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2012.056 ◽

2012 ◽

Vol 4 (1) ◽

pp. e2012056 ◽

Cited By ~ 6

Author(s):

Mohammad Erfan Zare

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Idiopathic Thrombocytopenic Purpura ◽

Eradication Therapy ◽

Complete Response ◽

Thrombocytopenic Purpura ◽

Platelet Counts ◽

Count Response ◽

Significant Difference ◽

H Pylori

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune hematological disordercharacterized by auto antibody-mediated platelet destruction. Although the main cause of ITPremains unclear, but its relationship with some infection was demonstrated. In recent years, many studies have demonstrated improvement of platelet counts in ITP patients after treating Helicobacter pylori infection. The aim of this study was to investigate the effects of H. pylori eradication on platelet count response in Iranian ITP patients.A total of 26 patients diagnosed with both ITP and H. pylori infection. ITP were diagnosed whose platelet counts were less than 100×103/μL. These patients were tested for H. pylori infection by Urea Breath Test and serum H. pylori antibody. All patients received triple therapy for 7 or 14 days to eradicate H. pylori infection. These patients followed for six months.Prevalence of H. pylori was 67.3%. H. pylori eradication achieved in 89.5% (26/29). Of the 26 patients, 15 (57.7%) exhibited a complete response (CR) and 11 (42.3%) were unresponsive. We did not find partial responders. There was a significant difference in the baseline platelet count of responders and non-responders patients (p<0.001). All responders had platelet count ≥50×103/μLand all non-responders had platelet count <50×103/μL.Results of this study revealed that eradication therapy of H. pylori infection can improve platelet counts in ITP patients especially with mild thrombocytopenia and support routine detection andtreatment of H. pylori infection in ITP patients in populations with a high prevalence of this infection.

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Role of Helicobacter pylori Eradication Therapy on Platelet Recovery in Chronic Immune Thrombocytopenic Purpura

Gastroenterology Research and Practice ◽

10.1155/2017/9529752 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Khan Sheema ◽

Ujjan Ikramdin ◽

Naz Arshi ◽

Naz Farah ◽

Sheikh Imran

Keyword(s):

Bone Marrow ◽

Helicobacter Pylori ◽

Immune Thrombocytopenic Purpura ◽

Eradication Therapy ◽

Bone Marrow Examination ◽

Thrombocytopenic Purpura ◽

Platelet Counts ◽

Chronic Immune Thrombocytopenic Purpura ◽

Chronic Itp ◽

H Pylori

Background. Idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder in which the immune system destroys native platelets. In this condition an autoantibody is generated against a platelet antigen. ITP affects women more often than men and is more common in children than adults. Objective. To assess the effect of Helicobacter pylori eradication therapy (HPET) on platelet count in Helicobacter pylori associated chronic immune thrombocytopenic purpura (chronic ITP) in adult. Materials and Methods. It is an interventional prospective study conducted at Liaquat University of Medical and Health Sciences, Jamshoro, from 2014 to 2015. A set of 85 patients diagnosed with chronic ITP were included in the study via convenient sampling. Patients with platelets count < 100 × 109/L for >3 months were selected. They were posed to first-line investigations which comprised complete blood count (CBC) and peripheral blood smear examination followed by second-line tests including bone marrow examination and Helicobacter pylori stool specific antigen (HpSA-EIA). Standard H. pylori eradication therapy was offered and the patients were assessed at regular intervals for 6 months. Results. Of the 85 study patients, 32 (37.6%) were male and 53 (62.3%) were female. Mean ages of H. pylori positive and negative subjects were 43.89 ± 7.06 and 44.75 ± 7.91 years, respectively. Bone marrow examination confirmed the diagnosis and excluded other related BM disorders. H. pylori stool antigen (HpSA) was detected in 34 (40%) patients and hence regarded as H. pylori positive; the rest were negative. Treatment with eradication therapy significantly improved the mean platelet counts from 48.56±21.7 × 109/l to 94.2±26.8 × 109/l. Conclusion. We concluded that the anti-H. pylori eradication therapy improves blood platelet counts in chronic immune thrombocytopenia.

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Does Helicobater pylori initiate or perpetuate immune thrombocytopenic purpura?

Blood ◽

10.1182/blood-2003-03-0900 ◽

2004 ◽

Vol 103 (3) ◽

pp. 890-896 ◽

Cited By ~ 104

Author(s):

Marc Michel ◽

Nichola Cooper ◽

Christelle Jean ◽

Christine Frissora ◽

James B. Bussel

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Prospective Study ◽

Immune Thrombocytopenic Purpura ◽

Breath Test ◽

Gastrointestinal Symptoms ◽

Thrombocytopenic Purpura ◽

H Pylori ◽

A Prospective Study

Abstract To determine the prevalence of Helicobacter pylori (H pylori) infection in North American patients with immune thrombocytopenic purpura (ITP) and the effect of H pylori eradication on the platelet count, a prospective study was performed. Seventy-four patients aged 10 years and older (mean age of 41 years) with chronic ITP and a platelet count below 60 × 109/L were enrolled. H pylori infection was found in 22% of patients by means of a breath test and could not be predicted by gastrointestinal symptoms. H pylori–positive patients (52.5 years of age) were older than H pylori–negative patients (38.5 years of age; P = .0035). Fifteen of the 16 H pylori–positive patients were treated and the bacteria was eradicated in 14 (93%). After 3 months, a significant response (platelet count > 50 × 109/L and doubling the initial count) was observed in only one patient. After a median follow-up of 11.5 months, none of the 14 patients had responded. Ten H pylori–negative patients treated with the same regimen also did not increase their platelet counts. In conclusion, unlike several previous reports, this study does not implicate H pylori in the pathogenesis of ITP since the prevalence of H pylori infection was low and eradication of H pylori did not positively influence the course of the ITP.

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Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review

Blood ◽

10.1182/blood-2008-07-167155 ◽

2009 ◽

Vol 113 (6) ◽

pp. 1231-1240 ◽

Cited By ~ 180

Author(s):

Roberto Stasi ◽

Ameet Sarpatwari ◽

Jodi B. Segal ◽

John Osborn ◽

Maria Laura Evangelista ◽

...

Keyword(s):

Systematic Review ◽

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Response Rate ◽

Complete Response ◽

Helicobacter Pylori Infection ◽

Thrombocytopenic Purpura ◽

Overall Response ◽

H Pylori

AbstractWhether the eradication of Helicobacter pylori infection can increase the platelet count in patients with immune thrombocytopenic purpura (ITP) is still a controversial issue. To provide evidence-based guidance, we performed a systematic review of the literature published in English, selecting articles reporting 15 or more total patients. We identified 25 studies including 1555 patients, of whom 696 were evaluable for the effects of H pylori eradication on platelet count. The weighted mean complete response (platelet count ≥ 100 × 109/L) and overall response (platelet count ≥ 30 × 109/L and at least doubling of the basal count) were 42.7% (95% confidence interval [CI], 31.8%-53.9%) and 50.3% (95% CI, 41.6%-59.0%), respectively. In 222 patients with a baseline platelet count less than 30 × 109/L, the complete response rate was 20.1% (95% CI, 13.5%-26.7%) and the overall response rate was 35.2% (95% CI, 28.0%-42.4%). The response rate tended to be higher in countries with a high background prevalence of H pylori infection and in patients with milder degrees of thrombocytopenia. These findings suggest that the detection and eradication of H pylori infection should be considered in the work-up of patients with seemingly typical ITP.

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Effect of Helicobacter pylori infection on the first-line treatment outcomes in patients with immune thrombocytopenic purpura

10.22541/au.162150339.96219653/v1 ◽

2021 ◽

Author(s):

Ali Dogan ◽

Omer Ekinci ◽

Senar Ebinc

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Eradication Therapy ◽

Line Treatment ◽

First Line ◽

Thrombocytopenic Purpura ◽

Significant Difference ◽

H Pylori ◽

First Line Treatment

Background: Helicobacter pylori (H. pylori) eradication therapy is known to increase the platelet count, but in immune thrombocytopenic purpura (ITP), the effect of H. pylori infection on the response to treatment is not clear. This study aims to determine whether the response to the first–line treatment is affected by the states of H. pylori–positivity and –negativity in ITP patients. Methods: Adult newly diagnosed or chronic ITP patients who had not received eradication therapy for H. pylori infection were included. Characteristics of the patients, presence and severity of bleeding, initial platelet count, administered treatments, and treatment response rates were inspected. Results: Of 119 total patients, 32 (26.9%) were H. pylori–positive, 87 (73.1%) were H. pylori–negative. The most common treatment was standard–dose steroid in both groups (62.5% vs 68.9%, p=0.524). Rates of complete response, partial response, no response were comparable for the two groups (respectively, 75% vs 73.6%, and 18.8% vs 19.5%, and 6.2% vs 6.9%), and there was no significant difference between the groups (p=0.283). Conclusion: It can be stated according to the present study that; in ITP patients in whom treatment is indicated, the response to the first–line treatment without the administration of H. pylori eradication therapy is comparable between H. pylori–positive and H. pylori–negative patients. Keywords: Helicobacter pylori, immune thrombocytopenic purpura, first-line treatment

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Helicobacter pylori induced Immune Thrombocytopenic Purpura and perspective role of Helicobacter pylori eradication therapy for treating Immune Thrombocytopenic Purpura

AIMS Microbiology ◽

10.3934/microbiol.2021018 ◽

2021 ◽

Vol 7 (3) ◽

pp. 284-303

Author(s):

Arham Ihtesham ◽

◽

Shahzaib Maqbool ◽

Muhammad Nadeem ◽

Muhammad Bilawal Abbas Janjua ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Treatment Efficacy ◽

Molecular Mimicry ◽

Eradication Therapy ◽

Surface Antigens ◽

Thrombocytopenic Purpura ◽

Platelet Surface ◽

H Pylori

<abstract> Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterised by production of autoantibodies against platelet surface antigens. Recent studies have demonstrated a paramount association of ITP and <italic>Helicobacter pylori (H-pylori)</italic> infection with significant rise in platelet count following <italic>H-pylori</italic> eradication therapy. The <italic>H-pylori</italic> infection induced ITP is validated by many proposed mechanisms such as molecular mimicry due to production of autoantibodies against <italic>H-pylori</italic> surface virulent factors (CagA) and cross reactivity of these antibodies with platelet surface antigens (GP IIb/IIIa, GP Ib/IX, and GP Ia/IIa), phagocytic perturbation due to enhanced phagocytic activity of monocytes, enhanced dendritic cell numbers and response, platelets aggregation due to presence of anti- <italic>H-pylori</italic> IgG and von Willebrand factor (vWf) and finally host immune response against <italic>H-pylori</italic> virulent factors CagA and VacA leading to ITP. The effectiveness of <italic>H-pylori</italic> eradication therapy has also been demonstrated with platelet count being used as a predictive factor for assessment of treatment efficacy. Out of 201 patients 118 were responding to the triple therapy and remaining 83 patients were non-responders, showing the response rate of 58.7%. Out of 118 responders 69 patients were showing complete response (CR) and 49 were showing partial response (PR) to the <italic>H-pylori</italic> eradication therapy. However, more studies are required to elucidate this association and treatment efficacy. </abstract>

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Does Helicobacter pylori Eradication Therapy Result in a Platelet Count Improvement in Adults with Immune Thrombocytopenic Purpura Regardless of H pylori Infection?

Hematology ◽

10.1182/asheducation-2008.1.31 ◽

2008 ◽

Vol 2008 (1) ◽

pp. 31-32 ◽

Cited By ~ 7

Author(s):

Donald M. Arnold ◽

Roberto Stasi

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Eradication Therapy ◽

Thrombocytopenic Purpura ◽

Helicobacter Pylori Eradication ◽

History Of ◽

H Pylori ◽

Helicobacter Pylori Eradication Therapy ◽

Therapy Result

AbstractA 34-year-old male with a long history of immune thrombocytopenic purpura (ITP) presents to your office. His platelet count is 30 × 109/L and he is clinically stable with no bleeding symptoms. He has read that Helicobacter pylori eradication therapy may be effective for ITP and he asks you about this. You do not have access to reliable tests for H pylori infection (e.g., urea breath test), yet you wonder about the benefit of empiric eradication therapy for your patient.

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Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles

Blood ◽

10.1182/blood-2006-12-063222 ◽

2007 ◽

Vol 110 (12) ◽

pp. 3833-3841 ◽

Cited By ~ 47

Author(s):

Giovanni Emilia ◽

Mario Luppi ◽

Patrizia Zucchini ◽

Monica Morselli ◽

Leonardo Potenza ◽

...

Keyword(s):

Helicobacter Pylori ◽

Chronic Gastritis ◽

Immune Thrombocytopenic Purpura ◽

Long Term Results ◽

Platelet Response ◽

Related Factors ◽

Thrombocytopenic Purpura ◽

Platelet Recovery ◽

Chronic Immune Thrombocytopenic Purpura ◽

H Pylori

AbstractEradication of Helicobacter pylori may lead to improvement of chronic immune thrombocytopenic purpura (ITP), although its efficacy over time is uncertain. We report the results of H pylori screening and eradication in 75 consecutive adult patients with ITP. We also used molecular methods to investigate lymphocyte clonality and H pylori genotypes in the gastric biopsies from 10 H pylori–positive patients with ITP and 19 H pylori–positive patients without ITP with chronic gastritis. Active H pylori infection was documented in 38 (51%) patients and successfully eradicated in 34 (89%) patients. After a median follow-up of 60 months, a persistent platelet response in 23 (68%) of patients with eradicated infection was observed; 1 relapse occurred. No differences in mucosal B- or T-cell clonalities were observed between patients with ITP and control participants. Of note, the frequency of the H pylori cagA gene (P = .02) and the frequency of concomitant H pylori cagA, vacAs1, and iceA genes (triple-positive strains; P = .015) resulted statistically higher in patients with ITP than in control participants. All asymptomatic H pylori–positive patients with ITP were suffering from chronic gastritis. Our data suggest a sustained platelet recovery in a proportion of patients with ITP by H pylori eradication alone. Overrepresentation of specific H pylori genotypes in ITP suggests a possible role for bacterium-related factors in the disease pathogenesis.

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