Platelet Activation in <i>Helicobacter pylori</i>-Associated Idiopathic Thrombocytopenic Purpura: Eradication Reduces Platelet Activation but Seldom Improves Platelet Counts

Abstract

Introduction: It has been suggested that Helicobacter pylori eradication often increases platelet counts in patients with chronic idiopathic thrombocytopenic purpura (ITP). In addition, H. pylori has been shown to induce platelet activation (CD62p or P-selectin expression) in previous studies. We assessed the response of platelet count and CD62p expression after eradication therapy in patients with ITP and H. pylori infection. Methods and Results: We prospectively studied 15 ITP patients diagnosed with H. pylori infection by serology and breath test. A follow-up breath test was used to document eradication. Two out of 15 patients showed improvement in platelet counts after 6 months, 1 of which may have had drug-induced thrombocytopenia. Overall, certain platelet response rate in our series was 6.7% (1/15). We found that platelet CD62p expression by flow cytometry was elevated in 10/15 (66.7%) H. pylori-infected patients, which is a statistically significant difference when compared with 3/33 (9.1%) control ITP patients seronegative for H. pylori (p = 0.002). In addition, eradication therapy decreased CD62p expression (p = 0.04). However, reduction in platelet activation was not associated with an increase in platelet counts (mean 72.4 × 10⁹/l before and 68.7 after therapy; p = 0.4). Conclusion: In our series, platelet activation was common in ITP patients with H. pylori, and eradication therapy decreased platelet activation but seldom increased platelet counts. Increased platelet CD62p expression is a putative link between chronic infections and atherosclerosis, but further study is needed to clarify the implications of our observation.

Definition, diagnosis and treatment of immune thrombocytopenic purpura

“…In contrast, only three studies have been reported from the United States and Canada and they have all reported lower frequencies of both H. pylori infection and platelet count response rates following eradication treatment. [7][8][9] These data suggest that H. pylori infection may be merely an incidental observation, not excluding the diagnosis of ITP and not clinically important for management. In between these alternative interpretations are studies reporting partial platelet count responses, suggesting that H. pylori infection may contribute to the thrombocytopenia in ITP but is not the sole cause.…”

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

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][28][29][30][31][32][33][34][35] The prevalence (51%) of bacterium …”

Helicobacter pylori—An Infectious Risk Factor for Atherosclerosis?

“…A large majority of studies have suggested that alterations in lipid metabolism due to chronic tion in the atherosclerotic process 138) . On the other hand, decreased platelet activation and a reduced CD62p expression are observed after successful H. pylori eradication, which further suggests a putative link between H. pylori infection and atherosclerosis 139) . These findings support the hypothesis that the association between H. pylori infection and atherosclerosis is, at least partly, due to platelet activation and increased platelet aggregation.…”