Variations in Mean Platelet Volume in Patients with Helicobacter pylori Infection before and after Eradication, Way before Immune Thrombocytopenia?

Helicobacter pylori (H. pylori) and immune thrombocytopenia (ITP) association is well known and eradication treatment has its place in both treatment guidelines. Since H. pylori eradication is followed by an increase in platelet counts in patients with immune thrombocytopenia, it is suggested that H. pylori be examined and treated if infection is present. There is only one study that demonstrated a relation between H. pylori and platelet indices in individuals with normal platelet counts. In this study, we aimed to investigate the effects of H. pylori infection on platelet count and mean platelet volume, which is a sign of increased platelet destruction in patients with normal platelet counts. We evaluated the data of 106 patients with urease test positivity before the eradication of bacteria and urea breath test negative after the eradication, in a retrospective manner. Mean platelet count in patients before the eradication treatment was 256.730 ± 66.380/mm3. After H. pylori was eradicated, it has been observed that the mean platelet count increased to 287.080 ± 59.240/mm3. Mean MPV of patients before and after eradication treatment were 9.35 ± 1.63 fL and 8.61 ± 1.48 fL. Mean MPV was higher when patients were infected with H. pylori. This study showed that there is an increase in platelet counts and a decrease in MPV levels with the eradication of the H. pylori. Our study is the first to investigate changes of mean platelet volume and platelet count before and after eradication of H. pylori infection in individuals with normal platelet counts.

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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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Effects of biological variations on platelet count in healthy subjects in China

Thrombosis and Haemostasis ◽

10.1160/th03-05-0276 ◽

2004 ◽

Vol 91 (02) ◽

pp. 367-372 ◽

Cited By ~ 18

Author(s):

Jing Yang ◽

Xiaojun Lu ◽

Tokuhiro Okada ◽

Tamiaki Kondo ◽

Changgeng Ruan ◽

...

Keyword(s):

Platelet Count ◽

Mean Platelet Volume ◽

Healthy Subjects ◽

Bleeding Time ◽

Platelet Volume ◽

Platelet Counts ◽

Normal Platelet Count ◽

Normal Platelet ◽

Low Platelet Count ◽

The Mean

SummaryThe effects of biological variations on platelet counts were investigated in 694 healthy subjects aged 18 to 60 years living in three cities including Chengdu (Sichuan Province), Suzhou (Jiangsu Province) and Harbin (Heilongjang Province) in China. Platelet counts in healthy subjects were significantly lower in Chengdu (52∼202 X 109/L) and Suzhou (60∼259 X 109/L) than in Harbin (154∼348 X 109/L)(p <0.0001), but the mean platelet volume (MPV) determined concurrently was negatively correlated with platelet count, the MPV values were significantly higher in Chengdu (11.8∼15.6 fl) and Suzhou (10.9∼15.8 fl) than in Harbin (9.5∼12.9 fl) (p < 0.0001). Platelet counts were significantly higher in summer (73∼289 X 109/L) than in winter (52∼202 X 109/L) (p <0.0001), but the MPV values were lower in summer (11.2∼14.7 fl) than in winter (11.8∼15.6 fl) (p <0.05) in Chengdu. Platelet associated immunoglobulin (PA-IgG) in Chengdu was revealed to be significantly higher in the low platelet count group (<150 X 109/L, 13.5 ± 7.1 ng/107 PLT) than in the normal platelet count group (≥150 X 109/L, 8.3 ± 2.7 ng/107 PLT)(p <0.0001). Similar results were observed in Suzhou for the reticulated platelet ratio, which was significantly higher in the low platelet count group (19.5 ± 7.1%) than in the normal platelet count group (11.6 ± 2.7%)(p <0.01). The bleeding time in Chengdu showed a significantly longer time in the low platelet count group (8.6 ± 2.3 min) than in the normal platelet count group (6.0 ± 1.2 min)(p <0.01). With regard to the effects of lipids on platelet counts, the HDL values were significantly higher in the normal platelet count group (1.60 ± 0.76 mmol/L) than the low platelet count group (1.23 ± 0.31 mmol/L) (p <0.01); but no significant differences in cholesterol and triglycerides values between the normal and low platelet count groups (p >0.05) were recorded. These findings suggest that the platelet counts could be greatly influenced in healthy subjects by biological variations such as geographical, seasonal, and lipid variations.

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Studies on Reference Intervals for Platelet Counts in Three Cities in China and one in Japan

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613162 ◽

2002 ◽

Vol 88 (07) ◽

pp. 111-114 ◽

Cited By ~ 3

Author(s):

Changgeng Ruan ◽

Yun Wu ◽

Tokuhiro Okada ◽

Shigemi Motoi ◽

Tamiaki Kondo ◽

...

Keyword(s):

Platelet Count ◽

Mean Platelet Volume ◽

Healthy Subjects ◽

Hematological Parameters ◽

Reference Interval ◽

Reference Intervals ◽

Sichuan Province ◽

Jiangsu Province ◽

Platelet Volume ◽

Platelet Counts

SummaryHematological parameters including platelet counts, etc. were determined in 1,140 healthy subjects living in four cities: Suzhou (Jiangsu Province), Chengdu (Sichuan Province) and Harbin (Heilongjang Province) in China, and Kobe in Japan. Then, the reference intervals for platelet counts were calculated and compared. The reference interval for platelet count of subjects aged between 18 and 60 years was 60-259 × 109/L in Suzhou and 52–202 × 109/L in Chengdu, and subjects with platelet counts of 100 × 109/L or less accounted for about 30% of the subjects examined in these cities. The reference intervals in Harbin and Kobe were within the range of 150–350 × 109/L, and no subject having a platelets count of 100 × 109/L or less was detected. Mean platelet volume (MPV) determined concurrently was negatively correlated with platelet count, and the reference intervals for MPV in Chengdu and Suzhou were higher than those in Harbin and Kobe.

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Clinical Features and Effects of Eradication on Helicobacter Pylori Positive 207 ITP Cases in Japan.

Blood ◽

10.1182/blood.v104.11.2071.2071 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2071-2071

Author(s):

Kingo Fujimura ◽

Masataka Kuwana ◽

Yoshiyuki Kurata ◽

Masahiro Imamura ◽

Hiroshi Harada ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Eradication Therapy ◽

The Other ◽

First Line ◽

Platelet Counts ◽

Count Response ◽

Successful Group ◽

H Pylori ◽

Over 40 Years

Abstract In 1998, Gasbarrini et al reported that in ITP cases with Helicobacter pylori (H.pylori) infection, elevation of platelet counts was observed by eradication of this bacterium. Since then, several reports from Italy and Japan confirmed the elevation of platelet counts after eradication. However, the characteristic background in the H.pylori positive ITP and eradication effects on platelet counts is unclear. On the other hand, reports from Spain, North Europe and USA could not show the evidence that eradication is effective on elevating platelet counts in H.pylori positive ITP. Therefore, we designed a nationwide retrospective study in Japan to evaluate the incidence of H.pylori positive ITP cases and the effects of eradication on platelet counts and to clear above problems. Four hundred and thirty-five ITP cases were enrolled over a period of one and half years (2002. 7~2003.12) from 12 hospitals. H. pylori infection was found in 300 cases(65%), who were significantly (P<0.005) older and showed hyperplastic megakaryocyte in bone marrow (P=0.011) comparison with negative cases. Eradication to H. pylori was performed in 207 H. pylori positive ITP cases and as a whole, the platelet count response was observed in 63% of eradication succeeded group. In the successful group, CR and PR rate were 23% and 42% respectively at 12 months after eradication. The platelet count response was significant in the successfully eradicated group (P<0.005) and the increased platelet count was maintained without ITP treatment for over 12 months. In conclusion, H. pylori infection was involved in most ITP patients over 40 years old in Japan and eradication therapy proved effective for increasing platelet counts even in splenectomy non-responsive cases and the platelet count response appeared one month after eradication. This evidence suggests that eradication therapy is the first line of treatment in H. pylori positive ITP patients.

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Helicobacter pylori eradication affects platelet count recovery in immune thrombocytopenia

Scientific Reports ◽

10.1038/s41598-020-66460-5 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Ayoung Lee ◽

Junshik Hong ◽

Hyunsoo Chung ◽

Youngil Koh ◽

Soo-Jeong Cho ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenia ◽

Complete Response ◽

Long Term Effects ◽

Infection Group ◽

Platelet Recovery ◽

First Line Therapy ◽

H Pylori ◽

Count Recovery

Abstract Helicobacter pylori (H. pylori) infection is on the rise as a cause of immune thrombocytopenia (ITP). It has been suggested that platelet recovery can be achieved following successful microbial eradication, although, the exact pathophysiology has yet to be fully elucidated. This study evaluated the long-term effects of H. pylori eradication monotherapy on platelet count recovery in patients with ITP. H. pylori eradication was analysed in 61 ITP patients. Patients who maintained a complete response (CR) for more than six months were classified as sustained responders (SR). The prevalence of H. pylori infection was 54.3% (75/138), and the success rate of eradication with first-line therapy was 71.4% (35/49). Patients who had achieved a CR at 2 months maintained a higher platelet count thereafter. At 1 year following eradication, platelet counts had increased 2.78 times in the eradicated group, 1.36 times in the sustained infection group, and 1.33 times in the no infection group compared with the baseline (P = 0.016).

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Improvement of platelet counts in steroid-unresponsive idiopathic immune thrombocytopenic purpura after short-course therapy with recombinant alpha 2b interferon [see comments]

Blood ◽

10.1182/blood.v74.6.1894.1894 ◽

1989 ◽

Vol 74 (6) ◽

pp. 1894-1897 ◽

Cited By ~ 58

Author(s):

SJ Proctor ◽

G Jackson ◽

P Carey ◽

A Stark ◽

R Finney ◽

...

Keyword(s):

Platelet Count ◽

Partial Response ◽

Immune Thrombocytopenia ◽

Initial Response ◽

Complete Responder ◽

Thrombocytopenic Purpura ◽

Platelet Counts ◽

Normal Platelet ◽

Short Course ◽

Steroid Refractory

Abstract In 13 patients with severe steroid-refractory idiopathic immune thrombocytopenia (ITP), a short course of recombinant alpha 2b interferon (IFN), given at a dose of 3 MU for 12 doses, caused a significant increase in platelet count in 11 patients. The rise in platelet count occurred following completion of the short course of IFN in 10 patients and occurred during therapy in one patient. Three patients showed an increase to normal platelet counts within 14 days of discontinuing the drug, eight showed a partial response, with a platelet count increase from 30 to 100 x 10(9)/L, and two patients showed minimal response. One complete responder relapsed at 5 months from initial response, and a further course of alpha 2b IFN caused a second prompt response with a rise of platelet count to supranormal levels. Short-course alpha 2b IFN can be recommended as a therapy for severe ITP. Responses are seen in splenectomized and nonsplenectomized subjects, and thrombocytopenia is not exacerbated during treatment.

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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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Megakaryocyte Apoptosis in the Bone Marrow of Patients with Immune Thrombocytopenia

Blood ◽

10.1182/blood.v128.22.1379.1379 ◽

2016 ◽

Vol 128 (22) ◽

pp. 1379-1379

Author(s):

John R Vrbensky ◽

Ishac Nazy ◽

Lisa J Toltl ◽

Catherine Ross ◽

John G. Kelton ◽

...

Keyword(s):

Bone Marrow ◽

Platelet Count ◽

Bone Marrow Biopsy ◽

Research Funding ◽

Immune Thrombocytopenia ◽

Tunel Staining ◽

Bone Marrow Biopsies ◽

Entire Study ◽

Platelet Counts ◽

Normal Platelet

Abstract Introduction: Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder in which autoantibodies promote the destruction and underproduction of platelets. Recent evidence suggests that immune-mediated destruction of bone marrow megakaryocytes is associated with the pathogenesis of this disease. In addition, the attenuation of megakaryocyte apoptosis can lead to platelet underproduction since this process appears to be involved in thrombopoiesis. In the current study, we investigated megakaryocyte apoptosis as a possible mechanism in the pathogenesis of ITP. Patients/Methods: Bone marrow biopsy sections from ITP patients and controls were stained with anti-human CD61 to enumerate megakaryocytes. Terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling (TUNEL) staining was performed as a measure of megakaryocyte apoptosis. The samples were coded and reviewed by an experienced hematopathologist who was blinded to the diagnosis. Adult primary ITP patients had isolated thrombocytopenia with no underlying cause and a platelet count less than 100 x109/L at the time of bone marrow biopsy procurement. Patients with secondary ITP (in the context of medications, lymphoproliferative disease, HIV, hepatitis B or C infection) were excluded, as were patients who received prior treatment with thrombopoietin receptor agonists or other hematopoietic growth factors. Thrombocytopenic controls were patients with myelodysplastic syndrome (MDS) who had platelet counts below 100 x109/L. Control patients with normal platelet counts had bone marrow biopsies performed as part of investigations for lymphoma or plasma cell dyscrasia with negative test results. Results: The average platelet count for ITP patients, MDS patients, and controls were 18 x109/L (range 2-76 x109/L), 29 x109/L (range 9-60 x109/L), and 281 x109/L (range 171-400 x109/L), respectively. Elevated megakaryocyte counts were observed in the bone marrow sections of 5/14 (36%) ITP patients, 0/8 (0%) MDS patients, and 2/11 (18%) controls. Megakaryocyte apoptosis was comparable between ITP patients and MDS patients [2/14 (14%) vs 1/8 (13%) (p=1.00)], while fewer ITP patients exhibited megakaryocyte apoptosis compared to controls with normal platelet counts [2/14 (14%) vs 7/11 (64%) (p=0.02)]. In the entire study cohort, the average platelet counts of patients with negative and positive TUNEL staining were 66 x109/L (range 2-378 x109/L) and 206 x109/L (range 20-400 x109/L), respectively (p=0.01). In addition, the normalized megakaryocyte counts (per high powered field) were 8.2 ± 5.5 and 5.4 ± 2.5 in patients with negative and positive TUNEL staining, respectively (p=0.05). Conclusion: Megakaryocyte apoptosis was reduced in ITP bone marrow samples compared to controls with normal platelet counts, but was also low in thrombocytopenic MDS patients. Reduced megakaryocyte apoptosis was found to be associated with a low platelet count, and may be related to thrombocytopenia regardless of etiology. Our study is consistent with the hypothesis that attenuated megakaryocyte apoptosis is relevant in the context of platelet underproduction in ITP. Disclosures Arnold: Novartis: Consultancy, Research Funding; Bristol Myers Squibb: Consultancy; UCB: Consultancy; Amgen: Consultancy, 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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The Clinical Efficacy of Helicobacter pylori Eradication in Patients with Helicobacter pylori-Positive Chronic Thrombocytopenic Purpura.

Blood ◽

10.1182/blood.v106.11.4002.4002 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4002-4002 ◽

Cited By ~ 1

Author(s):

Seung-Hyun Nam ◽

Bong-Seog Kim ◽

Jae Hoon Lee ◽

Hong Suk Song ◽

Sung-Hwa Bae ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Breath Test ◽

Urea Breath Test ◽

Rapid Urease Test ◽

Thrombocytopenic Purpura ◽

Platelet Recovery ◽

Chronic Itp ◽

Urease Test ◽

H Pylori

Abstract Background: Helicobacter pylori (H pylori) has been implicated in the pathogenesis of some autoimmune diseases including idiopathic thrombocytopenic purpura (ITP). Several studies recently showed a high prevalence of H pylori infection in patients with ITP and reported a platelet recovery after bacterial eradication therapy. The prevalence of H pylori infection and effect of its eradication in Korea patients with chronic ITP were investigated. Methods: The study included among 35 patients with chronic ITP from eight hospitals. H pylori infection was assessed by urea breath test, rapid urease test or microbial culture. H pylori eradication was performed with amoxicillin, clarithromycin and omeprazol regimen for 7 days or bismuth, metronidazol and tetracycline regimen for 10 days. Eradication was assessed by urea breath test 4 weeks after treatment. Platelet counts were monitored serially after the end of treatment. Results: Thirty five patients with chronic ITP were evaluated, including 12 males and 23 females. Median age was 57 years (range 30–79). The median platelet count before eradication was 23,000/uL (range 4,000–66,000/uL). Sixteen patients were performed the splenectomy previously. H pylori infection was found in 23 (65%) of 35 patients. In 21 patients performed the eradication, 6 patients (28.5%) had a significant increase in platelet count after 2 weeks and 2 months. The response duration was 1–27 (median 7.6) months. Conclusions: This study confirmed the efficacy of H pylori eradication in increasing platelet in adult chronic ITP patients. We must consider the investigation and eradication of H pylori infection in ITP patients as a simple, inexpensive tool in management of the chronic disease.

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