Steroid‐refractory chronic idiopathic thrombocytopenic purpura associated with hepatitis C virus infection

Sakuraya, Masataka; Murakami, Hirokazu; Uchiumi, Hideki; Hatsumi, Nahoko; Akiba, Tohoru; Yokohama, Akihiko; Maekawa, Takafumi; Tsukamoto, Norifumi; Morita, Kimio; Karasawa, Masamitsu; Ogawara, Hatsue; Nojima, Yoshihisa

doi:10.1034/j.1600-0609.2002.00509.x

Cited by 42 publications

(36 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…30,31,37 Epidemiology Six cross-sectional studies have reported serologic evidence of HCV infection in 159 of 799 (20%) patients with a clinical diagnosis of CITP (Table 1). 30,31,[37][38][39][40] In the largest series published to date, HCV antibodies were identified in 76 (30%) of 250 patients fulfilling the ASH guideline criteria for CITP. 31 There were significant differences in demographic characteristics of patients with HCV-positive compared with HCV-negative CITP.…”

Section: Hcv Infectionmentioning

confidence: 99%

Viral-Associated Immune Thrombocytopenic Purpura

Liebman

2008

Hematology

View full text Add to dashboard Cite

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.

show abstract

Section: Hcv Infectionmentioning

confidence: 99%

Viral-Associated Immune Thrombocytopenic Purpura

Liebman

2008

Hematology

View full text Add to dashboard Cite

show abstract

“…Clinically, patients with Sjögren's syndrome and thrombocytopenia are significantly younger and have a higher tendency to have accompanying skin eruptions and anti-SS-B antibody than those without (7). On the other hand, the majority of patients with immune thrombocytopenic purpura related to HCV need treatment such as PSL and splenectomy, with the response to PSL much poorer than those unrelated to HCV (15). Thus, we would implicate the present case's thrombocytopenia in CHC rather than a complication of Sjögren's syndrome based on the following reasons: high titers of serum HCV RNA, negative anti-SS-A/SS-B antibodies, severe and recurrent thrombocytopenia in spite of PSL treatment, and high age at onset.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, we would implicate the present case's thrombocytopenia in CHC rather than a complication of Sjögren's syndrome based on the following reasons: high titers of serum HCV RNA, negative anti-SS-A/SS-B antibodies, severe and recurrent thrombocytopenia in spite of PSL treatment, and high age at onset. PSL, interferon alpha (IFN-), and splenectomy are favored in the treatment of thrombocytopenia associated with CHC (15)(16)(17). Here, we chose PSL rather than IFN-because successful treatment with PSL for thrombocytopenia associated with HCV was reported without exacerbation of liver function (17); treatment with IFN-per se sometimes induces thrombocytopenia in CHC (18).…”

Section: Discussionmentioning

confidence: 99%

“…PSL was indeed effective, but its efficacy did not last long and thrombocytopenia recurred several times with concomitant increases in HCV RNA and serum ALT level. It is sometimes very difficult to select the treatment modality for thrombocytopenia associated with HCV (15)(16)(17)(18). Under these circumstances, it is very necessary to accumulate patients like the present case to pursue safer and more effective treatments.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sjoegren's Syndrome Associated with Chronic Hepatitis C, Severe Thrombocytopenia, Hypertrophic Cardiomyopathy, and Diabetes Mellitus

et al. 2005

View full text Add to dashboard Cite

A 74-year-old woman with Sjögren's syndrome and chronic hepatitis C (CHC) was admitted to our hospital in October 2003 for treatment of diabetes mellitus. She had the past history of recurrent thrombocytopenia, which was proven to be due to peripheral destruction. Although she had been diagnosed with hypertrophic cardiomyopathy (HCM) for 2 years, she had never felt palpitation. She suddenly died probably of fatal arrhythmia related to HCM during the last hospitalization.

show abstract

“…Aunque no se conocen los mecanismos involucrados en el desarrollo de estos anticuerpos antiplaquetarios, se ha observado que el VHC tiene capacidad de unión a las plaquetas, al igual que el VIH (24)(25)(26)(27); esta característica del virus favorecería el desarrollo de nuevos antígenos sobre la superficie de las plaquetas mediante la modificación en la conformación de las glucoproteínas plaquetarias, lo cual propiciaría el desarrollo de anticuerpos autorreactivos (25,26). Otros mecanismos inmunoló-gicos que podrían estar involucrados en el desarrollo de esta púrpura trombocitopénica, son el depósito de complejos inmunes inespecíficos en la superficie plaquetaria (19,31) o la presencia de anticuerpos anticardiolipina (32), lo cual nos demuestra el carácter complejo de esta etiología.…”

Section: Hepatitis Viralunclassified

Papel de los anticuerpos antiplaquetarios en la infección viral: una revisión sistemática de la literatura

et al. 2011

View full text Add to dashboard Cite

Introducción. La trombocitopenia es un fenómeno frecuente en las infecciones virales. Uno de los mecanismos propuesto como posible explicación de su desarrollo es la destrucción plaquetaria periférica mediada por anticuerpos antiplaquetarios. Objetivo. Revisar los resultados de los trabajos originales que existen en la literatura sobre infección viral y anticuerpos antiplaquetarios en humanos, y su efecto sobre el recuento total de plaquetas. Materiales y métodos. Se hizo una búsqueda en PubMed empleando la combinación de términos: "viral infection (OR Virus diseases) AND antibody antiplatelet (OR thrombocytopenia); y antibody antiplatelet AND HIV (OR Measles, OR Dengue, OR Chickenpox OR varicella, OR Epstein Barr, OR Mumps, OR Rubella". Se obtuvieron 218 referencias, de las cuales, 65 correspondían al objetivo de la revisión. Resultados. En la búsqueda se encontró que la trombocitopenia mediada por anticuerpos antiplaquetarios se ha documentado en infecciones virales por VIH, sarampión, dengue, varicelazóster, Epstein-Barr, parotiditis y rubéola. La presencia de anticuerpos antiplaquetarios en infecciones virales por VIH, virus de Epstein-Barr y dengue, se ha asociado con la presencia de la trombocitopenia y con la gravedad de la enfermedad. Conclusiones. Aunque la aparición de anticuerpos antiplaquetarios no se considera el único mecanismo que explica la trombocitopenia desarrollada en las infecciones virales mencionadas, de acuerdo con la literatura científica disponible, su presencia se asocia con la gravedad de la trombocitopenia y con potenciales implicaciones clínicas en los pacientes.Palabras clave: virosis, anticuerpos, plaquetas, trombocitopenia, humanos. Roll of antibodies antiplatelets in viral infection: a systematic review of literatureIntroduction. Thrombocytopenia is a frequent phenomenon in viral infections. Peripheral platelet destruction mediated by anti-platelet antibodies has been one of the proposed causal mechanisms. Objective. Results were collected and analyzed from published studies on associations of human viral infections on anti-platelet antibodies and total platelet counts. Materials and methods. A PubMed search was conducted using the following terms: Viral infection (OR Virus diseases) AND antiplatelet antibody (OR thrombocytopenia) AND HIV (OR measles OR dengue OR chickenpox OR varicella OR Epistein Barr OR mumps OR rubella). Two hundred eighteen reference hits were obtained, 65 of which were relevant to this review. Results. Antiplatelet antibody-mediated thrombocytopenia has been documented in cases of HIV, measles, dengue, chickenpox, Epstein-Barr, mumps and rubella. Moreover, the presence of these antibodies has been associated with severity the disease and thrombocytopenia in viral infections. Conclusions. Although the presence of antiplatelet antibodies was not the only mechanism for explaining the thrombocytopenia developed in these viral infections, their presence was associated with severity of thrombocytopenia and with the clinical presentation of these patients.

show abstract

Steroid‐refractory chronic idiopathic thrombocytopenic purpura associated with hepatitis C virus infection

Abstract: Given these findings, we recommend that HCVab is measured upon diagnosis of chronic ITP, and that splenectomy is planned in patients with HCVab in the event that prednisolone treatment is ineffective.

Cited by 42 publications

References 27 publications

Viral-Associated Immune Thrombocytopenic Purpura

Viral-Associated Immune Thrombocytopenic Purpura

Sjoegren's Syndrome Associated with Chronic Hepatitis C, Severe Thrombocytopenia, Hypertrophic Cardiomyopathy, and Diabetes Mellitus

Papel de los anticuerpos antiplaquetarios en la infección viral: una revisión sistemática de la literatura

Contact Info

Product

Resources

About