Helicobater Pylori Infection and Clinical Response to Eradication Therapy in Patients with Immune Thrombocytopenic Purpura (ITP).

Abstract We performed a prospective study in order to investigate the controversial association between HP infection and immune thrombocytopenic purpura (ITP). We studied the prevalence of HP infection and the efficacy of its eradication in 57 consecutive adult patients admitted to our ward for ITP. Thirty-three patients were females and 24 were males (median age 58 years; mean platelet count 68±42 x109/L). HP infection was demonstrated by the stool antigen test in 28 patients (49.1%). Such prevalence increased with the age. No statistical difference by gender, platelet count, disease duration, presence of specific platelet autoantibodies (MACE) and therapy regimens was observed between HP-positive and negative patients. On the other HP positive patients were significantly older than HP negative ones (62 versus 54 years, p<0,03) and presented more gastroenteric symptoms (32% versus 7%, p<0,05). Thirteen patients with chronic ITP were given HP eradication since their platelet count was above 20x109/L and they do not need for starting or modifying therapy of ITP for at least 6 months. HP eradication was performed by standard triple therapy based on omeprazole plus clarithromycin and amoxicillin for 1 week. The bacteria was eradicated in all cases. Twelve HP negative ITP patients were followed as controls. The mean platelet count was significantly increased in ITP patients after 3 and 6 months from HP eradication. However, considering as end-point, a platelet count increase of more than 50% over the basal value, the platelet response to the HP eradication appears to be better in eradicated patients only after 3 months of follow-up (83% of positive response versus 57%). We also studied in HP-positive patients the presence of antibodies against CagA citotoxic protein by ELISA method. Seventeen of the patients have anti-CagA antibodies (56%) but the positivity did not correlate with platelet response to the eradication. In conclusion the prevalence of HP infection in our patients with ITP was comparable to that observed in the adult population from the same geographic area. Infection is not associated with clinical or laboratory distinctive features with the exception of tan older age and gastroenteric symptoms. The eradication of the HP infection seems to improve mean platelet count in ITP patients but larger prospective studies are required to validate this approach. Platelet response to the HP eradication in HP positive ITP patients and in HP negative controls Platelets (x 109/L, mean ± SD) basal time 1 month 3 months 6 months 12 months * p<0.05 vs basal platelet count ITP Patients 13 HP+ eradicated 74±43 141±142 129±73* 104±54* 160±117 12 HP- controls (not eradicated) 62±35 76±33 73±40 78±51 76±48

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Efficacy of Helicobacter pylori Eradication Therapy on Platelet Recovery in Pediatric Immune Thrombocytopenic Purpura-Case Series and a Systematic Review

Microorganisms ◽

10.3390/microorganisms8101457 ◽

2020 ◽

Vol 8 (10) ◽

pp. 1457

Author(s):

Tamaki Ikuse ◽

Masanori Toda ◽

Kosuke Kashiwagi ◽

Kimiko Maruyama ◽

Masumi Nagata ◽

...

Keyword(s):

Systematic Review ◽

Helicobacter Pylori ◽

Immune Thrombocytopenic Purpura ◽

Pediatric Patients ◽

Eradication Therapy ◽

Platelet Response ◽

Thrombocytopenic Purpura ◽

Helicobacter Pylori Eradication ◽

H Pylori ◽

Helicobacter Pylori Eradication Therapy

Evidence relating to the efficacy of Helicobacter pylori eradication therapy for chronic immune thrombocytopenic purpura (cITP) in childhood is inadequate. The aim of this retrospective study was to determine the efficacy of H. pylori eradication therapy for platelet response in pediatric patients with cITP in our hospital, and to perform a systematic review of previous reports about pediatric patients with cITP who were positive for H. pylori infection and were treated with H. pylori eradication therapy. Analysis of the data of pediatric patients with cITP in our hospital and a systematic review of digital literature databases of studies in pediatric patients with cITP were performed. Data of 33 pediatric patients with cITP from our hospital records showed that the prevalence of H. pylori infection and the rate of response to platelet therapy were 15% and 33.3%, respectively. Data of 706 pediatric patients from 18 previous reports showed that the prevalence of H. pylori infection and rate of platelet response were 23% and 43.8%, respectively. Eradication therapy for H. pylori infection in pediatric cITP patients can be expected to result in a response equivalent to that in the adult population, with fewer adverse effects than other treatments for cITP.

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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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Safety and Efficacy of Thrombopoietin Analogs in the Treatment of Chronic Thrombocytopenic Purpura in Children: A Systematic Review

Blood ◽

10.1182/blood-2021-151173 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4215-4215

Author(s):

Usman Ali Akbar ◽

Vivek Soorya Sathya Moorthy ◽

Sudeep Yadav ◽

Saman Bahram ◽

Adnan Mehboob Qureshi ◽

...

Keyword(s):

Clinical Trials ◽

Platelet Count ◽

Placebo Group ◽

Observational Study ◽

Immune Thrombocytopenic Purpura ◽

Research Funding ◽

Pediatric Population ◽

Platelet Response ◽

Thrombocytopenic Purpura ◽

Double Blinded

Abstract Introduction Immune thrombocytopenic purpura (ITP) is an autoimmune disorder consisting of low platelet count, purpura, and hemorrhagic episodes, caused by antiplatelet autoantibodies. Children who develop chronic or refractory ITP are at risk of bleeding after failing first-line therapies. Thrombopoietin analogs -Eltrombopag and romiplostim are safe and effective treatment options. Thrombopoietin receptor agonists (TPO-Ras) improve platelet production by activating the thrombopoietin pathway. They also stimulate megakaryocytes and hematopoietic stem cells. We analyzed the efficacy and toxicity of romiplostim and eltrombopag in chronic immune thrombocytopenic purpura in the pediatric population (1-17 years). Materials/Methods Following the PRISMA guidelines, we performed a comprehensive literature search on Pubmed, Embase, Cochrane Library, Web of Science, and Clinicaltrials.gov. We used the following keywords, "Thrombopoitein analogs", "TPOs", "Immune thrombocytopenic purpura", "Eltrombopag" and "Romiplostim" MeSh terms from the inception of data till 06/17/2021. We screened initial results from the search of 358 articles focusing on the pediatric population and finally included 9 clinical trials and 1 observational study. We excluded all case reports, case series, preclinical trials, review articles, and meta-analyses. We extracted the data for efficacy (platelet response, baseline platelet count, and Platelet count at first response) and safety (Bleeding or Grade ≥ 3 Adverse Events). Results: Romiplostim A total of 185 patients were analyzed in five clinical trials and 1 observational study employing Romiplostim in the treatment group. Platelet response (PR) (platelet count >50 × 109/L) has been reported in all the studies. In 3 randomized double-blinded control trials by Bussel 2011, Elfaly 2011, and Tarantino 2016, Romiplostim achieved a platelet response of 81.69% vs 12.9% in the placebo group. The other three studies reported substantial platelet response as stated in table 1. In all the studies 25 participants had a prior splenectomy. The most common side effects reported in the studies were bleeding (56.75%), headache (58.64%), contusion (50.76%), and epistaxis (49.23%). Clinically significant bleeding (grade 2-4) was reported by 2 studies in Romiplostim vs placebo group (71.08% vs 96%). Eltrombopag A total of 246 patients were analyzed in five clinical trials and 1 observational study. In a randomized double-blinded multicenter study by Grainger et al., Eltrombopag achieved a PR of 39.68% vs 3.4% in the placebo group. Other clinical trials reported a PR of 55.85% whereas the observational study by Neuner et al. reported a PR of 72% in the patient population. Clinically significant bleeding was reported by Grainger et al. and was 47 % in the eltrombopag group vs 7% in the placebo group. Fifteen patients in all the studies had a prior splenectomy. Conclusion: Thrombopoietin analogs such as romiplostim and eltrombopag show substantial platelet response and are associated with minimal side effects. However, more randomized clinical trials are needed to compare their head-to-head efficacy and safety in the treatment of chronic immune thrombocytopenic purpura in pediatric patients. Figure 1 Figure 1. Disclosures Anwer: Janssen pharmaceutical: Honoraria, Research Funding; GlaxoSmithKline: Research Funding; Allogene Therapeutics: Research Funding; BMS / Celgene: Honoraria, Research Funding.

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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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Clinical Features, Treatment, and Outcome of Severe HIV-Associated Immune Thrombocytopenic Purpura In the HAART Era

Blood ◽

10.1182/blood.v116.21.2522.2522 ◽

2010 ◽

Vol 116 (21) ◽

pp. 2522-2522

Author(s):

Kimberley LS Ambler ◽

Linda M Vickars ◽

Chantal S Leger ◽

Lynda M Foltz ◽

Julio SG Montaner ◽

...

Keyword(s):

Platelet Count ◽

Hepatitis C ◽

Hepatitis B ◽

Clinical Features ◽

Hiv Risk ◽

Immune Thrombocytopenic Purpura ◽

Red Blood Cell Transfusion ◽

Platelet Response ◽

Thrombocytopenic Purpura ◽

History Of

Abstract Abstract 2522 Background: The association between HIV and immune thrombocytopenic purpura (ITP) is well documented. Although HIV-associated ITP responds both to highly active anti-retroviral therapy (HAART) and treatments used in classic ITP, the clinical features of HIV-associated ITP were documented prior to the widespread use of HAART, and there are currently no widely accepted guidelines for the management of HIV-associated ITP. Here we describe the clinical features, treatment, and outcomes of patients diagnosed with severe HIV-associated ITP in the HAART era. Methods: We searched the BC Centre for Excellence in HIV/AIDS (CFE) database to identify patients with ≥ 1 platelet count <20 × 109/L since January 1996, the year HAART was widely adopted in British Columbia. The cutoff value of <20 × 109/L was chosen as a clinically relevant platelet count since these patients generally require treatment. Patient charts were reviewed, clinical data extracted, and only patients with a diagnosis of ITP made by a hematologist were included in the analysis. Descriptive statistics were used to summarize the data. Results: Of 8922 patients in the CFE database since 1996, 31 (0.3%) with a diagnosis of ITP and a platelet count <20 × 109/L were identified. The median age at ITP diagnosis was 37 (range 27–66) years and 25 (81%) were male. The median platelet count was 6 (2-19) × 109/L and median hemoglobin 129 (34-165) g/L. Eighteen patients (51%) presented with clinical bleeding and 4 (13%) required packed red blood cell transfusion. Sixteen (62%) of 26 patients with a documented HIV risk factor had a history of injection drug use (IDU). Four patients (13%) were coinfected with the hepatitis B virus and 12 (39%) with hepatitis C. At ITP diagnosis, 8 of 29 patients (28%) had a CD4 count <200 cells/mL and the median CD4 was 290 (20-600) cells/mL; 5 had a prior AIDS-defining opportunistic infection or neoplasm. Although 29 patients received antiretrovirals at some point, only 10 (32%) were receiving HAART at ITP diagnosis. A bone marrow aspirate and biopsy was performed in 6 patients (19%) and was consistent with ITP in all. Initial ITP treatment included: IVIG, n=12; steroids, n=10; anti-RhD, n=8; HAART, n=3. The median number of treatments received was 1 (0-3) and median time to a platelet count >20 × 109/L was 13.5 (1-1379) days. Median platelet response within 30 days was 58 (5-322) × 109/L (n=26) but only 3 patients (10%) achieved a platelet count in the normal range. At a median follow-up of 48 (0.2-138) months, 27 patients (87%) required secondary ITP treatment for a recurrent platelet count <20 × 109/L; median 10 (5-20) × 109/L, including 8 of 13 patients receiving HAART with initial ITP therapy. Secondary ITP treatment included: IVIG, n=9; anti-RhD, n=6; steroids, n=4; splenectomy, n=3; danazol, n=1; and HAART, n=1. Median platelet response to secondary treatment was 42 (21-198) × 109/L. Response to ITP treatment was not significantly associated with treatment received but was lower in the following patients: 4/15 with comorbidities (5 related to the liver) vs 10/16 without; 1/21 IDU vs 4/10 with sexual HIV risk; and 4/13 with hepatitis B or C coinfection vs 13/16 without (p<0.05 for all). Complications of ITP treatment occurred in 2 patients: psychiatric effect of steroids, n=1; and post-splenectomy fever and hematoma, n=1. There were 4 deaths, causes were: GI bleed, n=2; Evan's syndrome and hepatic failure, n=1; advanced HIV, n=1. Of the 4 patients that died, 3 had a history of IDU. Comorbidities in patients who died included: hepatitis C, n=3; hepatic cirrhosis, n=2; portal hypertension, n=1; hepatocellular failure, n=1. One patient who died of GI bleeding had a history of IDU, hepatitis C coinfection, and died of variceal bleeding despite a normal platelet count following splenectomy. Conclusions: Most patients with severe HIV-associated ITP diagnosed in the HAART era achieved a safe platelet count with primary ITP treatment and there were few treatment complications. However, nearly all required retreatment for severe ITP, including 8 of 13 patients receiving HAART with initial ITP therapy. Inferior platelet response was associated with a history of IDU, comorbidities, and hepatitis B or C coinfection, and 3 of 4 deaths occurred in patients with a history of IDU, therefore new approaches to the treatment of severe ITP in this patient population are needed. This is to our knowledge the largest series of HIV-associated ITP reported in the era of HAART. Disclosures: No relevant conflicts of interest to declare.

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Efficacy and Safety of a New Intravenous Immunoglobulin Product in Patients with Chronic Immune Thrombocytopenic Purpura.

Blood ◽

10.1182/blood.v110.11.1307.1307 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1307-1307

Author(s):

Tadeusz Robak ◽

Abdulgabar Salama ◽

Lidia Kovaleva ◽

Yaroslava I. Vyhovska ◽

Simon Davies ◽

...

Keyword(s):

Platelet Count ◽

Adverse Events ◽

Intravenous Immunoglobulin ◽

Primary Endpoint ◽

Immune Thrombocytopenic Purpura ◽

Efficacy And Safety ◽

Platelet Response ◽

Thrombocytopenic Purpura ◽

Platelet Counts ◽

Chronic Itp

Abstract Background Intravenous immunoglobulin (IVIG) is an accepted treatment for immune thrombocytopenic purpura (ITP). A new liquid 10% human IgG preparation stabilized with proline at a pH of 4.8 (trade name: Privigen) was recently developed. It can be stored at room temperature and is therefore always ready to use. Here we report its efficacy and safety in patients with chronic ITP. Patients and Methods Fifty-seven patients with chronic ITP and a platelet count below 20 x 109/L were included in this open-label, single arm, multi-center Phase III trial. IVIG was given at a dose of 1 g/kg on 2 consecutive days at a maximum infusion rate of 4 mg/kg/min. A subset (56.1%) of the patients received premedication (acetaminophen or diphenhydramine) to avoid adverse events. The primary endpoint was the platelet response rate, defined as the percentage of patients showing an increase in platelet count to ≥50 x 109/L within 7 days of the first infusion. Secondary endpoints included platelet counts at specified time points, time to platelet response, duration of platelet response, and regression of hemorrhages at different bleeding sites. Safety was evaluated by the frequency and severity of adverse events. Results The primary endpoint, an increase in platelet counts to ≥50 x 109/L, was achieved by 81% of the subjects (95% CI: 69–89%). The highest median platelet count (149 x 109/L) was observed on day 8. Median time to response was 2.5 days, with 43% of subjects responding within 1 day. Median duration of platelet response (days with platelet count ≥ 50 x 109/L) was 15.4 days. Regression rates for various bleeding sites ranged from 78% to 100%. Regression of bleeding correlated with increases in platelet counts. Adverse events were reported in 52 (91%) subjects. The most common adverse event was headache (67%), the incidence and severity of which was attenuated by premedication with acetaminophen/diphenhydramine. There were 3 serious adverse events, one of which (aseptic meningitis) was considered related to the study medication. Conclusions The present study has shown the safety and significant efficacy of a novel, 10% liquid, ready for use IVIG preparation, in patients with chronic ITP. A rapid increase in platelet counts to a level where severe bleeding episodes become more unlikely was seen in the majority of patients, as expected with IVIG given at 1 g/kg on 2 consecutive days. The increase in platelet counts was associated with a regression of bleeding. Adverse events were generally mild to moderate in severity, corresponded to those expected with IVIG, and could be prevented with premedication.

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The Efficacy of H. pylori Eradication Therapy in H. pylori-Infected and Uninfected Patients with Immune Thrombocytopenic Purpura: A Systematic Review.

Blood ◽

10.1182/blood.v112.11.3413.3413 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3413-3413

Author(s):

Donald M. Arnold ◽

Ashley Bernotas ◽

Ishac Nazi ◽

Roberto Stasi ◽

Masataka Kuwana ◽

...

Keyword(s):

Systematic Review ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Immune Modulation ◽

Eradication Therapy ◽

Independent Effect ◽

Thrombocytopenic Purpura ◽

Count Response ◽

Central Registry ◽

H Pylori

Abstract Introduction: Helicobacter pylori eradication therapy results in the improvement of thrombocytopenia in up to 60% of patients with chronic immune thrombocytopenic purpura (ITP). Whether this effect is directly linked to H. pylori eradication, or to other effects of the treatment such as immune modulation or the eradication of other commensal bacteria, remains uncertain. We performed a systematic review of the literature to determine the independent effect of H. pylori eradication therapy on the platelet count in ITP by comparing its efficacy in H. pylori-infected and uninfected patients. Methods: All studies examining the platelet response following H. pylori eradication therapy in patient with ITP who were, and who were not, infected with H. pylori were included. No language or age restrictions were applied. Article selection, data abstraction and assessment of study quality were performed in duplicate. We searched MEDLINE, EMBASE, Cochrane central registry, abstracts from the American Society of Hematology (from 2003), canvassed experts and hand searched bibliographies of relevant articles. Results: The initial search yielded 265 citations of which 101 were excluded after screening for relevance, and an additional 154 were excluded because they did not meet eligibility criteria. Ten studies (8 from Japan), were included. In total, 333 patients were enrolled, 68.2% female, mean (+/− SD) age 51.6 +/− 17 years. Mean baseline platelet count was 42 +/− 26 x109/L, mean prior duration of ITP was 30.7 +/− 49 months, and 38 patients (11.4%) had undergone splenectomy. H. Pylori infection was confirmed by the urea breath test, and eradication therapy consisted of amoxicillin 750 – 1500mg twice daily, clarithromycin 200 – 400mg twice daily, and a proton pump inhibitor for 7 days in most studies. We identified 201 H. pylori-positive and 59 H. pylori-negative patients treated with eradication therapy. Eradication was achieved in 164 (94.3%) H. pylori infected patients. The overall platelet count response (variably defined) following eradication therapy for H. pylori-positive, eradicated, and negative patients was 52.7%, 54.3% and 3.4%, respectively (p <0.0001 for eradicated vs. negative). Similarly, pooling the results of only those studies employing a homogeneous response criteria (platelet count increase to 40 x109/L or higher at 3 – 6 months), the overall response for H. pylori-positive (n=121), eradicated (n=116), and negative (n=39) patients was 50.4%, 51.7% and 5.1% respectively (p<0.0001). Of the 10 reported patients with non-eradicated H. pylori infection, 2 achieved a platelet count response following eradication therapy. Mean time to response was 2.4 weeks, and mean duration of response was 15.7 months. Mild adverse events were reported in 12 patients. Conclusion: Our findings suggest that the benefit derived from H. pylori eradication therapy on platelet count response in patients with ITP is mostly due to H. pylori eradication, and not to the treatment itself. Eradication therapy should be offered only to those patients with confirmed H. pylori infection. Randomized trials in consecutive ITP patients are needed to confirm this observation.

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Association of Immune Thrombocytopenic Purpura with Non-Bleeding Symptoms

Blood ◽

10.1182/blood.v116.21.4674.4674 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4674-4674

Author(s):

Sumit Talwar ◽

Mala Varma

Keyword(s):

Quality Of Life ◽

Platelet Count ◽

Psychological Health ◽

Immune Thrombocytopenic Purpura ◽

Adult Population ◽

Severe Bleeding ◽

Thrombocytopenic Purpura ◽

Female Ratio ◽

Platelet Counts

Abstract Abstract 4674 Immune thrombocytopenic purpura (ITP) is an autoimmune disorder defined by isolated thrombocytopenia in the absence of a clinically apparent cause. The patients most commonly report mild to moderate bleeding symptoms; severe bleeding is rare even with very low platelet counts. Patients with ITP have been shown to have a reduced quality of life compared to the general population, as shown by McMillan et al using the SF-36 questionnaire. Also, patients receiving treatment for ITP have been shown by Mathias et al, using the ITP-PAQ (patient assessment questionnaire), to have significantly lower scores for health-related scales including symptoms, fatigue/sleep, bother, activity, psychological health, and overall quality of life in comparison with patients with ITP not on treatment. Blatt et al reported that thrombocytopenia per se can manifest with constitutional symptoms which resolve with improvement of thrombocytopenia. They conducted a retrospective data review of 27 patients (between ages 6 months to 15 years) and showed that 6 (22%) patients, including 4 patients with chronic ITP, reported fatigue related to their low platelet counts. Their symptoms improved with an increase in the platelet counts. There is no data in the adult population regarding the presence of any symptoms other than bleeding as a manifestation of thrombocytopenia. We conducted a retrospective chart review involving patients diagnosed with ITP between January 2002 and August 2010. All these patients were followed by a single physician hence reducing reporting bias. A total of 30 patients with a median age of 49 years (range 30 yrs to 84 yrs) were included in the study. The male to female ratio was 3:7. Based on the experience with one patient who complained of fatigue associated with thrombocytopenia which improved with an increase in platelet counts, the physician decided to collect data on all constitutional symptoms associated with thrombocytopenia. All of the comorbidities and any coexistent abnormalities which could explain these symptoms were recorded. A total of 8 (26.7%) patients with a median age of 44 years (range 31 yrs to 75 yrs) reported fatigue associated with lower platelet counts; of these patients, one patient also complained of headaches and one patient also complained of bone pain (Table 1). The median platelet count at presentation was 13,000/μ L (range 3000/μ L – 75,000/μ L). All of these symptoms resolved with an increase in their platelet counts. Nine patients out of the total population were on chronic danazol treatment; only one of these patients complained of fatigue. None of the patients received chronic steroid therapy. Table 1: Characteristics of patients complaining of constitutional symptoms related to a decrease in platelet counts from their baseline. Subject Age (yrs) Sex (M: male, F: female) Symptom Platelet count at presentation (/μ L) 1 31 F Fatigue 22,000 2 69 F Fatigue 13,000 3 75 F Fatigue 9,000 4 49 F Fatigue 75,000 5 37 F Fatigue 10,000 6 44 M Fatigue 3,000 7 44 F Fatigue, Bone pains 38,000 8 40 F Fatigue, Headache 28,000 This is the first study in an adult population to assess the relationship of thrombocytopenia to constitutional symptoms. Our results are comparable to those reported in the pediatric population by Blatt et al. The mechanism of fatigue in relation to low platelet counts is not clear. Currently, treatment guidelines for ITP are based upon platelet counts and the risk of bleeding. However, further studies will be needed to evaluate if fatigue or any other symptoms which can impair the quality of life of patients can also become an important factor in deciding treatment initiation. Disclosures: No relevant conflicts of interest to declare.

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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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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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