Immunologic thrombocytopenic purpura as presenting symptom of hepatitis C infection

Bauduer, Frédéric; Marty, Fabrice; Larrouy, Marc; Ducout, Louis

doi:10.1002/(sici)1096-8652(199804)57:4<338::aid-ajh12>3.0.co;2-4

Cited by 35 publications

(28 citation statements)

References 7 publications

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“…This association is particularly significant when compared with the prevalence of HCV in our age-matched healthy controls (0´4%). The clinical and laboratory data of our HCV-positive thrombocytopenic patients showed trends similar to those of most other reports of HCV-associated thrombocytopenia (Silva et al, 1992;Pawlotsky et al, 1995;Linares et al, 1996;Bauduer et al, 1998;Gerli et al, 1999). In our series, thrombocytopenia was the presenting manifestation of HCV infection in all cases.…”

Section: Discussionsupporting

confidence: 90%

“…Several reports (Silva et al, 1992;Pawlotsky et al, 1995;Linares et al, 1996;Bauduer et al, 1998;Gerli et al, 1999), mostly from southern Europe, have shown an increased prevalence (5±35%) of hepatitis C virus (HCV) infection in patients with chronic acquired thrombocytopenia. The pathogenic mechanism of the thrombocytopenia in these patients has not been defined as symptoms of portal hypertension or splenomegaly were not evident in most of the cases.…”

mentioning

confidence: 99%

“…The proposed mechanisms for induction of thrombocytopenia in chronic HCV infection invoke the direct involvement of HCV. These mechanisms include (i) direct infection by HCV of megakaryocyte/platelet lineage, leading to underproduction of platelets (Silva et al, 1992;Nagamine et al, 1996), and/or (ii) dysregulation of the host immune system, leading to destruction of platelets (Wang et al, 1992;Alter, 1995;Nagamine et al, 1996;Bauduer et al, 1998).…”

mentioning

confidence: 99%

“…The various treatment used, including steroids, intravenous immunoglobulin (IVIg) and splenectomy, have generally produced only transient responses (Durand et al, 1994;Linares et al, 1996;Bauduer et al, 1998). In addition, steroids generally increase hepatitis C viraemia in these HCV-positive patients (Magrin et al, 1994).…”

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confidence: 99%

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HCV‐associated thrombocytopenia: clinical characteristics and platelet response after recombinant α2b‐interferon therapy

García‐Suárez¹,

Burgaleta²,

Hernanz³

et al. 2000

Br J Haematol

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Summary. Hepatitis C virus (HCV) has been proposed as a possible causative agent of chronic thrombocytopenia. We investigated HCV infection in a series of 51 unselected Spanish patients with chronic acquired thrombocytopenia. Anti-HCV and HCV viraemia were detected in 13/51 (22´5%) of cases; this prevalence was particularly significant when compared with HCV seropositivity in agematched controls (0´4%). Anti-HCV-positive patients, four men and nine women with a median age of 59´3 years (range 36±72), had a mean platelet count of 55´8 Â 10 9 /l (range 12±96). Only one of our HCV-positive thrombocytopenic patients had hypersplenism. Platelet-associated IgG (PAIgG) was negative, as measured by immunofluorescent flow cytometric analysis in 11/13 HCV-positive thrombocytopenic patients. Thus, thrombocytopenia in our HCV-positive patients appeared to be non-autoimmune mediated. In six patients, a trial of recombinant a2b-interferon (IFN-a) given at a dose of 3 MU three times per week for 6±24 months gave a durable (. 1 year) and significant increase in platelet count in all six patients. The maximum increase occurred after 6 months of IFN-a therapy. In conclusion, the ability of IFN-a to increase platelet counts in HCV-positive thrombocytopenic patients supports mechanisms involving a direct role for HCV inhibiting platelet production.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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HCV‐associated thrombocytopenia: clinical characteristics and platelet response after recombinant α2b‐interferon therapy

García‐Suárez¹,

Burgaleta²,

Hernanz³

et al. 2000

Br J Haematol

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“…The various treatment modalities--including steroids, IV Igs, and splenectomy--have failed to achieve lasting responses. 2,3,23 IFN treatment has been investigated in isolated HCV-related thrombocytopenia in some studies, 2 of which have reported sustained improvement of thrombocytopenia, even in the first weeks of treatment, n,13 However, in the present case, thrombocytopenia improved in the first 4 weeks but was subsequently exacerbated. In addition, viral load failed to decrease by >2 logs.…”

Section: Discussionmentioning

confidence: 61%

Combination therapy with pegylated interferon plus ribavirin in the treatment of hepatitis C virus-related thrombocytopenia

Karakan

Cındoruk

Değertekın

et al. 2005

Current Therapeutic Research

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Background: Isolated thrombocytopenia is a common manifestation of hepatitis C virus (HCV) infection. There is no established treatment modality for this condition. The efficacy of standard interferon 0FN) monotherapy has been reported in some studies. The major disadvantage of this treatment is the high rate of recurrence due to viral breakthrough during the first 12 weeks of treatment. Pegylated IFNs are now the standard regimen for chronic hepatic disease due to HCV infection. However, due to a lack of evidence, pegylated IFNs are not widely used for HCV-related isolated thrombocytopenia.Objective: The aim of this report was to present the case of a male patient with severe symptomatic thrombocytopenia due to HCV infection. Methods:Thrombocytopenia was treated with pegylated IFN plus ribavirin. Results: Although standard IFN monotherapy failed to achieve virologic and hematologic improvement, therapy with pegylated IFN alfa-2a plus ribavirin was associated with both virologic and hematologic improvement without any significant adverse effects. Conclusions: INTRODUCTIONExtrahepatic manifestations of hepatitis C virus (HCV) infection are observed in -38% to 50% of cases~; one of these manifestations is mild to moderate thrombocytopenia. Hepatic disease or cirrhosis with portal hypertension commonly leads to hypersplenism-related thrombocytopenia. Nonetheless, thrombocytopenia is more severe in HCV infections than in other hepatic diseases, possibly because of increased autoimmunity related to HCV infection. In HCV-related thrombocytopenia and idiopathic thrombocytopenic purpura (ITP), large thrombocytes are seen on peripheral smears, and a normal or elevated megakaryocyte count is seen in bone marrow aspirates, indicating peripheral destruction of thrombocytes. Interferons (IFNs) are used in clinical practice for the treatment of HCV infection. 1 Standard IFN monotherapy has been reported in some studies. 1 Although the main effect of IFNs on HCV is the suppression of replication, 1 other beneficial effects include immunomodulation of the host immune system. However, the major disadvantage of this treatment is the high rate of recurrence due to viral breakthrough during the first 12 weeks of treatment. 2 In addition, few studies have reported improvement in HCV-related thrombocytopenia with IFN therapy, 3 and current guidelines 4 do not mention the treatment of HCV-related thrombocytopenia with IFNs. Pegylated IFNs are now the standard regimen for chronic hepatic disease due to HCV infection. However, due to a lack of evidence, pegylated IFNs are not widely used for HCV-related isolated thrombocytopenia.Herein we report a case of HCV-related severe thrombocytopenia treated with IFN alfa-2a, with a fluctuating response. The patient provided written consent to use this material for publication.

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Risk of Immune Thrombocytopenic Purpura and Autoimmune Hemolytic Anemia Among 120 908 US Veterans With Hepatitis C Virus Infection

et al. 2009

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Background There is emerging evidence that Hepatitis C virus (HCV) infection plays a role in the etiology of immune thrombocytopenia purpura (ITP) and autoimmune hemolytic anemia (AIHA) which both are severe autoimmune cytopenias. Methods In order to determine if HCV infection increases the risk for ITP and AIHA, we calculated the incidence rates of ITP and AIHA among 120,691 HCV-infected and 454,905 matched HCV-uninfected U.S. veterans diagnosed 1997–2004. After excluding individuals with a prior diagnosis of a lymphoproliferative disease, HIV, or cirrhosis, we fit Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) as measures of risks. Results We found 296 ITP and 90 AIHA cases. Among HCV-infected versus HCV-uninfected persons, the overall incidence rates of ITP were 30.2 and 18.5 per 100,000 person-years, and for AIHA they were 11.4 and 5.0 per 100,000 person-years, respectively. HCV was associated with elevated risks for ITP (HR=1.8, 95% CI 1.4–2.3) and AIHA (HR=2.8, 95% CI 1.8–4.2). ITP incidence was increased among both untreated and treated HCV-infected persons (HR 1.7, 95% CI 1.3–2.2, and HR 2.4, 95% CI 1.5–3.7, respectively), whereas AIHA incidence was elevated only among treated HCV-infected persons (HR 11.6, 95% CI 7.0–19.3). Conclusions Individuals infected with HCV are at an increased risk for ITP, while the development of AIHA appears to be associated with HCV treatment. It may be beneficial to test individuals newly diagnosed with ITP for HCV infection.

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Immunologic thrombocytopenic purpura as presenting symptom of hepatitis C infection

Cited by 35 publications

References 7 publications

HCV‐associated thrombocytopenia: clinical characteristics and platelet response after recombinant α2b‐interferon therapy

HCV‐associated thrombocytopenia: clinical characteristics and platelet response after recombinant α2b‐interferon therapy

Combination therapy with pegylated interferon plus ribavirin in the treatment of hepatitis C virus-related thrombocytopenia

Risk of Immune Thrombocytopenic Purpura and Autoimmune Hemolytic Anemia Among 120 908 US Veterans With Hepatitis C Virus Infection

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