Platelet autoantibodies are common in hepatitis C infection, irrespective of the presence of thrombocytopenia

Panzer, Simon; Seel, Esther; Brunner, Markus; Körmöczi, Günther F.; Schmid, M; Ferenci, Péter; Peck‐Radosavljevic, Markus

doi:10.1111/j.0902-4441.2006.t01-1-ejh2888.x

Cited by 46 publications

(30 citation statements)

References 45 publications

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“…41,42 There have been conflicting data reported with respect to the presence of specific antibodies in platelet eluates from patients with HCVrelated ITP. 41,42,47,48 In the latter report, 66% of patients infected with HCV had detectable anti-platelet glycoprotein antibodies. However, their presence did not correlate with the patients' platelet counts.…”

Section: Hcv Infectionmentioning

confidence: 89%

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Viral-Associated Immune Thrombocytopenic Purpura

Liebman

2008

Hematology

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Chronic immune thrombocytopenic purpura (CITP) is a diagnosis of exclusion that occurs either de novo or secondary to other underlying disorders. Chronic infection with human immunodeficiency virus (HIV)andChronic immune thrombocytopenic purpura (CITP) is characterized by accelerated platelet destruction and variably impaired platelet production resulting in thrombocytopenia. CITP has been classified either as a primary autoimmune disorder (idiopathic thrombocytopenic purpura) or as secondary to a number of underlying disorders. Common conditions associated with secondary CITP include lymphoproliferative disorders and other autoimmune collagen vascular diseases. CITP is also associated with certain chronic infections. While the association between human immunodeficiency virus (HIV) infection and immune thrombocytopenia has been well known for over 20 years, recent studies have suggested that infection with Helicobacter pylori or hepatitis C virus (HCV) may be an even more frequent cause of chronic thrombocytopenia.The relationship between these chronic infections and the development of immune-mediated thrombocytopenia represents a largely unexplored paradigm in which the host response to an infectious agent results in a loss of immune self-regulation. The pathophysiology of infection-related ITP involves diverse immunologic pathways as well as nonimmune mechanisms that accelerate platelet destruction and/or decrease platelet production. A diagnosis of CITP associated with these chronic infections must include consideration of other potential causes of thrombocytopenia. For example, thrombocytopenia with HCV infection can also result from the hepatic cirrhosis leading to portal hypertension with splenic platelet sequestration and/or decreased hepatic production of thrombopoietin. However, the relationship between the infectious agent itself and the development of thrombocytopenia is clearly demonstrated by the improvements in platelet counts that follows successful treatment of the underlying infection. Therefore, the diagnostic and therapeutic algorithm for managing infection-related ITP can differ significantly from that of primary, i.e., idiopathic, thrombocytopenic purpura.

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Section: Hcv Infectionmentioning

confidence: 89%

“…However, their presence did not correlate with the patients' platelet counts. 48 A similar frequency of antiplatelet glycoprotein antibodies was found in patients with alcoholic cirrhosis, indicating these antibodies were not specific for HCV infection. 48 …”

Section: Hcv Infectionmentioning

confidence: 90%

Viral-Associated Immune Thrombocytopenic Purpura

Liebman

2008

Hematology

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“…We did not include antiplatelet antibodies in our study because of prior evidence that they are not responsible for thrombocytopenia in CHC, but there is conflicting evidence on this point. 11, 18 One possible mechanism affecting the platelet count in CHC is that HCV infects the bone marrow. Another potential mechanism is that platelets are increasingly sequestered in a fibrotic liver, though this was not apparent in our examination of liver biopsies stained for platelets.…”

Section: Discussionmentioning

confidence: 99%

“…However, previous reports of CHC patients have found that the presence of antiplatelet antibodies did not affect the platelet count. 18 Vascular endothelial dysfunction has also been found to play a role in thrombocytopenia in patients with CHC. Namely, von Willebrand Factor (vWF) and thrombomodulin have been found to be significantly correlated with the platelet count in patients with CHC.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with the platelet count in patients with chronic hepatitis C

Tana

Zhao

Bradshaw

et al. 2015

Thrombosis Research

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Background There are many potential causes of thrombocytopenia in patients with chronic hepatitis C (CHC). Aims We sought to determine the association between thrombopoietin (TPO) level, immature platelet fraction (IPF), immunoglobulin G (IgG) level, spleen size, and the platelet count in CHC. Methods We studied a consecutive sample of patients enrolled in an observational study at a referral-based research center, excluding subjects based on eligibility criteria. TPO, glycocalicin, and von Willebrand Factor (vWF) levels were determined using stored sera. Hepatic fibrosis was assessed via transient elastography (TE) when available, and clinical laboratory values and radiologic data were obtained from the medical record. We performed analyses of the relationships between independent variables and the platelet count. Results On univariate analysis, the following variables were significantly associated with the platelet count: age, alanine aminotransferase (ALT), direct bilirubin, total bilirubin, IPF, international normalized ratio (INR), spleen size, vWF, glycocalicin, fibrosis stage on liver biopsy, and TE (P-values all <0.05). A multivariable model determined that imputed TE score, TPO, IPF, and spleen size were independently associated with the platelet count (P-values all < 0.05). Conclusions The platelet count in CHC is significantly associated with fibrosis, TPO level, IPF, and spleen size. Our findings challenge the proposed mechanism of decreased TPO levels or decreased bone marrow production of platelets as a cause of thrombocytopenia in CHC. Future studies focusing on the effects of fibrosis and splenomegaly on platelets may shed more light on the pathophysiology of thrombocytopenia in patients with CHC.

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“…increase gradually as the severity of liver disease increases, suggesting that prolonged HCV infection causes marked immune system abnormalities. 8,13 Antiplatelet-antibody titers were found to be high in most of the patients with chronic HCV infection.…”

Section: Conflicts Of Interestmentioning

confidence: 99%

Hepatitis C Virus Infection Among Patients with Chronic Immune Thrombocytopenic Purpura in Northern India

Varma

Kumar

Garg

et al. 2011

Journal of Clinical and Experimental Hepatology

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Background: Hepatitis C virus (HCV) has been reported to be associated with the occurrence of autoimmune disorders, including immune thrombocytopenic purpura (ITP). This has suggested that HCV could be responsible for thrombocytopenia in these patients. This study was performed to estimate the frequency of HCV infection in patients of chronic ITP (cITP), and to find the frequency of thrombocytopenia in chronic HCV infection. Materials: A total of 150 subjects were included in the study. Fifty consecutive adult patients with cITP (> 6 months' duration) and 50 age-matched patients with chronic HCV were included for comparison of platelet counts in two groups. Fifty age-matched healthy subjects were also included in the control group. All patients' sera were tested for the presence or absence of HCV-RNA. Anti-HCV antibodies were tested in patients as well as in controls. Complete blood count and examination of peripheral blood smear were done followed by bone-marrow aspiration to confirm the diagnosis of ITP. Results: Three patients (6%) were tested positive for anti-HCV antibodies while no subject was positive in control group (P = 0.24). The prevalence of severe thrombocytopenia (platelet counts < 50,000/mL) was significantly higher in ITP patients compared with that in chronic HCV patients (P = 0.0001). Thrombocytopenia occurred more frequently in patient with moderate to severe than mild stage of fibrosis (P = 0.001). Conclusion: In conclusion, thrombocytopenia in ITP patients was not associated with HCV infection. The prevalence of thrombocytopenia was more common and more severe in ITP patients when compared with that in patients with chronic HCV. Thrombocytopenia in chronic HCV patients was related to the stage of fibrosis and to the duration of HCV infection. (J CLIN EXP HEPATOL 2011;1:68-72)

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Platelet autoantibodies are common in hepatitis C infection, irrespective of the presence of thrombocytopenia

Abstract: While platelet autoantibodies are common in individuals with HCV infection, their detection does not assist in the diagnosis of immune thrombocytopenia.

Cited by 46 publications

References 45 publications

Viral-Associated Immune Thrombocytopenic Purpura

Viral-Associated Immune Thrombocytopenic Purpura

Factors associated with the platelet count in patients with chronic hepatitis C

Hepatitis C Virus Infection Among Patients with Chronic Immune Thrombocytopenic Purpura in Northern India

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