1
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Han R, He HC, Zhang WN, Pan ZT, Feng CY, Liang MJ, Wu MY, Zhong W, Lin WQ. Investigation of the correlation between platelet antibodies and peripheral blood cytopenia in patients with hepatocellular carcinoma. Sci Rep 2024; 14:9705. [PMID: 38678158 PMCID: PMC11055914 DOI: 10.1038/s41598-024-60603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/25/2024] [Indexed: 04/29/2024] Open
Abstract
The primary triggers that stimulate the body to generate platelet antibodies via immune mechanisms encompass events such as pregnancy, transplantation, and blood transfusion. Interestingly, our findings revealed that a subset of male patients with hepatocellular carcinoma (HCC), despite having no history of transplantation or blood transfusion, has shown positive results in platelet antibody screenings. This hints at the possibility that certain factors, potentially related to the tumor itself or its treatment, may affect antibody production. To delve the causes we initiated this study. We employed a case-control study approach to analyze potential influential factors leading to the positive results via univariate and multivariate regression analysis. We utilized Kendall's tau-b correlation to examine the relationship between the strength of platelet antibodies and peripheral blood cytopenia. Antitumor medication emerged as an independent risk factor for positive results in HCC patients, and the strength of platelet antibodies positively correlated with the severity of anemia and thrombocytopenia. Without history of blood transfusion, transplantation, pregnancy, those HCC patients underwent recent tumor medication therapy are experiencing peripheral erythrocytopenia or thrombocytopenia, for them platelet antibody screenings holds potential clinical value for prevention and treatment of complications like drug-immune-related anemia and/or bleeding.
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Affiliation(s)
- Rui Han
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Hui-Chan He
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Wan-Ning Zhang
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Ze-Tao Pan
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Chen-Yang Feng
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Ming-Jian Liang
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Mei-Yi Wu
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Wei Zhong
- Department of Internal Medicine, Huangpu Hospital of Traditional Chinese Medicine, 3 Xieshan Road, Huangpu District, Guangzhou, 510700, People's Republic of China.
| | - Wen-Qian Lin
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China.
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2
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Huang CE, Chen WM, Wu YY, Shen CH, Hsu CC, Li CP, Chen MC, Chang JJ, Chen YY, Lu CH, Shi CS, Chen CC. Comparison of antiplatelet antibody profiles between hepatitis C virus-associated immune thrombocytopenia and primary immune thrombocytopenia. Platelets 2020; 32:1043-1050. [DOI: 10.1080/09537104.2020.1820975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Cih-En Huang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Ming Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yu-Ying Wu
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chien-Heng Shen
- Division of Gastroenterology and Hepatology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Chen Hsu
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chian-Pei Li
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Min-Chi Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Public Health and Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan
| | - Jung-Jung Chang
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Yang Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chang-Hsien Lu
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chung-Sheng Shi
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Cheng Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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3
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Newland AC, Sánchez‐González B, Rejtő L, Egyed M, Romanyuk N, Godar M, Verschueren K, Gandini D, Ulrichts P, Beauchamp J, Dreier T, Ward ES, Michel M, Liebman HA, de Haard H, Leupin N, Kuter DJ. Phase 2 study of efgartigimod, a novel FcRn antagonist, in adult patients with primary immune thrombocytopenia. Am J Hematol 2020; 95:178-187. [PMID: 31821591 PMCID: PMC7004056 DOI: 10.1002/ajh.25680] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
Primary immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder, characterized by a low platelet count (<100 × 109 /L) in the absence of other causes associated with thrombocytopenia. In most patients, IgG autoantibodies directed against platelet receptors can be detected. They accelerate platelet clearance and destruction, inhibit platelet production, and impair platelet function, resulting in increased risk of bleeding and impaired quality of life. Efgartigimod is a human IgG1 antibody Fc-fragment, a natural ligand of the neonatal Fc receptor (FcRn), engineered for increased affinity to FcRn, while preserving its characteristic pH-dependent binding. Efgartigimod blocks FcRn, preventing IgG recycling, and causing targeted IgG degradation. In this Phase 2 study, 38 patients were randomized 1:1:1 to receive four weekly intravenous infusions of either placebo (N = 12) or efgartigimod at a dose of 5 mg/kg (N = 13) or 10 mg/kg (N = 13). This short treatment cycle of efgartigimod in patients with ITP, predominantly refractory to previous lines of therapy, was shown to be well tolerated, and demonstrated a favorable safety profile consistent with Phase 1 data. Efgartigimod induced a rapid reduction of total IgG levels (up to 63.7% mean change from baseline), which was associated with clinically relevant increases in platelet counts (46% patients on efgartigimod vs 25% on placebo achieved a platelet count of ≥50 × 109 /L on at least two occasions, and 38% vs 0% achieved ≥50 × 109 /L for at least 10 cumulative days), and a reduced proportion of patients with bleeding. Taken together, these data warrant further evaluation of FcRn antagonism as a novel therapeutic approach in ITP.
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Affiliation(s)
- Adrian C. Newland
- Department of Haematology, Centre for HaematologyThe Royal London HospitalLondonUK
| | | | - László Rejtő
- Department of HematologyJósa András Teaching HospitalNyíregyházaHungary
| | - Miklos Egyed
- Department of HematologyKaposi Mor Teaching HospitalKaposvarHungary
| | | | - Marie Godar
- argenx BVBAIndustriepark‐Zwijnaarde 7ZwijnaardeBelgium
| | | | | | | | - Jon Beauchamp
- argenx BVBAIndustriepark‐Zwijnaarde 7ZwijnaardeBelgium
| | | | - E. Sally Ward
- Department of Molecular and Cellular MedicineTexas A&M University Health Science CenterCollege StationTexas
- Centre for Cancer ImmunologyUniversity of SouthamptonSouthamptonUK
| | - Marc Michel
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto‐Immunes de l'AdulteCentre Hospitalier Universitaire Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris, Université Paris Est CréteilCréteilFrance
| | - Howard A. Liebman
- Jane Anne Nohl Division of Hematology, Department of MedicineUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Hans de Haard
- argenx BVBAIndustriepark‐Zwijnaarde 7ZwijnaardeBelgium
| | | | - David J. Kuter
- Department of HematologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
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4
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Hawkins J, Aster RH, Curtis BR. Post-Transfusion Purpura: Current Perspectives. J Blood Med 2019; 10:405-415. [PMID: 31849555 PMCID: PMC6910090 DOI: 10.2147/jbm.s189176] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/22/2019] [Indexed: 12/15/2022] Open
Abstract
Post transfusion purpura (PTP) is an uncommonly reported post transfusion adverse event that can present with severe thrombocytopenia; sometimes resulting in significant bleeding and hemorrhage. Its diagnosis can be elusive given its substantial symptomatic overlap with other thrombocytopenic syndromes. Underdiagnosis and underreporting make the true incidence of disease difficult to define. While clinical suspicion is key, laboratory evidence of platelet-targeted antibodies and identification of the antigen(s) they recognize are necessary to confirm the diagnosis. A curious aspect of PTP is paradoxical destruction of both transfused and autologous platelets. Although the first case was reported over 50 years ago, this aspect of PTP pathogenesis is still not fully understood and is widely debated. Several theories exist, but conclusive evidence to support most is lacking. Despite limited understanding of disease incidence and etiology, treatment with IVIG (Intravenous Immunoglobulin) has become standard practice and can be highly effective. Although recurrence is rare, precautions should be taken if patients with a history of PTP require transfusions in the future.
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Affiliation(s)
- Jaleah Hawkins
- Versiti, Blood Center of Michigan, Grand Rapids, MI, USA
| | - Richard H Aster
- Versiti, Blood Center of Wisconsin, Milwaukee, WI, USA.,Blood Research Institute, Milwaukee, WI, USA
| | - Brian R Curtis
- Versiti, Blood Center of Wisconsin, Milwaukee, WI, USA.,Blood Research Institute, Milwaukee, WI, USA
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5
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6
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Lindholm PF, Kwaan HC, Ramsey G, Curtis BR, Fryer J. Severe thrombocytopenia in a patient following liver transplantation caused by HPA-1a antibodies produced by the liver donor. Am J Hematol 2018; 93:150-153. [PMID: 29044602 DOI: 10.1002/ajh.24944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Brian R. Curtis
- Platelet & Neutrophil Immunology Lab and Blood Research Institute, Blood Center of Wisconsin; Milwaukee Wisconsin 53233
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7
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Gurevich-Shapiro A, Bonstein L, Spectre G, Atweh N, Gruenewal T, Shapiro M, Tadmor B, Raanani P. Intravenous immunoglobulin-induced acute thrombocytopenia. Transfusion 2017; 58:493-497. [PMID: 29193103 DOI: 10.1111/trf.14419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/09/2017] [Accepted: 10/18/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) has known efficacy in various hematologic conditions, including immune thrombocytopenic purpura. STUDY DESIGN AND METHODS We present the clinical course of a patient with splenic marginal zone lymphoma, who developed acute thrombocytopenia on three consecutive episodes, with nadir counts of 27 × 109 , 50 × 109 , and 9 × 109 /L, upon administration of Intratect IVIG for hypogammaglobulinemia. An immunofluorescence test applying flow cytometry and monoclonal antibody immobilization of platelet antigens (MAIPA) assay were used to evaluate the reaction between IgG present in the IVIG preparations and the patient's or healthy donors' platelets (PLTs). RESULTS A strong direct binding reaction was observed between the patient's PLTs and Intratect IgG using both methods. A similar reaction failed to materialize with controls. Binding was not antigen specific according to MAIPA. CONCLUSIONS This is the first reported case of thrombocytopenia as a possible adverse effect of IVIG.
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Affiliation(s)
- Anna Gurevich-Shapiro
- Internal Medicine H, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tiqwa, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Lilach Bonstein
- Platelet Immunology Laboratory, Rambam Medical Center, Haifa, Israel
| | - Galia Spectre
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tiqwa, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Nardeen Atweh
- Platelet Immunology Laboratory, Rambam Medical Center, Haifa, Israel
| | - Tsipora Gruenewal
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tiqwa, Israel
| | - Michael Shapiro
- Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Boaz Tadmor
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tiqwa, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tiqwa, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
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8
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Gangaraju R, Rets A, Smock KJ, Heikal NM. Rare complication of treated immune thrombocytopenia. Am J Hematol 2017; 92:1262-1266. [PMID: 28801925 DOI: 10.1002/ajh.24884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 08/03/2017] [Accepted: 08/09/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Radhika Gangaraju
- Division of Hematology-Oncology; Department of Medicine, University of Utah; Salt Lake City Utah
| | - Anton Rets
- Department of Pathology; University of Utah Health Sciences Center, and ARUP Laboratories Institute for Clinical and Experimental Pathology; Salt Lake City Utah 84108
| | - Kristi J. Smock
- Department of Pathology; University of Utah Health Sciences Center, and ARUP Laboratories Institute for Clinical and Experimental Pathology; Salt Lake City Utah 84108
| | - Nahla M. Heikal
- Department of Pathology; University of Utah Health Sciences Center, and ARUP Laboratories Institute for Clinical and Experimental Pathology; Salt Lake City Utah 84108
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9
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Thude H, Bischoff W, Sterneck M, Marget M, Nashan B, Koch M. Polymorphisms of the human platelet antigen-1, -2, -3, -5, and -15 systems and acute cellular liver transplant rejection. Hum Immunol 2017; 78:534-539. [PMID: 28705752 DOI: 10.1016/j.humimm.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022]
Abstract
The human platelet antigen (HPA)-1, -2, -3, -5, and -15 systems are characterized as polymorphic alloantigens expressed on platelets and endothelial cells. In this retrospective study, we investigated, whether HPA-1, -2, -3, -5, and -15 incompatibilities are associated with acute cellular liver transplant rejection. A total of 96 Caucasian liver transplant recipients and corresponding donors were analyzed, 43 with biopsy proven acute cellular rejection (BPAR) and 53 without acute cellular rejection (No-BPAR). Polymorphisms of mentioned HPA systems were determined by polymerase chain reaction-sequence specific primers (PCR-SSP). Our data demonstrate that acute cellular rejection episodes were associated with HPA-3 incompatibility (58% HPA-3 incompatibility in BPAR group vs. 32% HPA-3 incompatibility in No-BPAR group, p=0.013). Furthermore, the frequency of HPA-3bb genotype was significantly higher in BPAR recipients as compared to No-BPAR recipients (30% vs 6%, p=0.002). On the other hand, there was no association between acute cellular rejection and the other tested HPA systems. We conclude that in the Caucasian population the HPA-3 system confers susceptibility to acute cellular rejection after liver transplantation.
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Affiliation(s)
- Hansjörg Thude
- University Medical Center Hamburg-Eppendorf, Department of Hepatobiliary and Transplant Surgery, Martinistraße 52, 20246 Hamburg, Germany.
| | - Wiebke Bischoff
- University Medical Center Hamburg-Eppendorf, Department of Hepatobiliary and Transplant Surgery, Martinistraße 52, 20246 Hamburg, Germany
| | - Martina Sterneck
- University Medical Center Hamburg-Eppendorf, Department of Hepatobiliary and Transplant Surgery, Martinistraße 52, 20246 Hamburg, Germany
| | - Matthias Marget
- University Medical Center Hamburg-Eppendorf, Institute for Transfusion Medicine, Martinistraße 52, 20246 Hamburg, Germany
| | - Björn Nashan
- University Medical Center Hamburg-Eppendorf, Department of Hepatobiliary and Transplant Surgery, Martinistraße 52, 20246 Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Institute for Transfusion Medicine, Martinistraße 52, 20246 Hamburg, Germany
| | - Martina Koch
- University Medical Center Hamburg-Eppendorf, Department of Hepatobiliary and Transplant Surgery, Martinistraße 52, 20246 Hamburg, Germany
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10
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Pârvu A, Zsoldos IA, Bojan A. Platelet concentrates transfusion - modern immunological issues. REV ROMANA MED LAB 2017. [DOI: 10.1515/rrlm-2017-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrada Pârvu
- “Iuliu Hatieganu” University of Medicine and Pharmacy , Cluj-Napoca , Romania
- “Prof. dr. Ion Chiricuța” Oncological Institute , Cluj-Napoca , Romania
| | | | - Anca Bojan
- “Iuliu Hatieganu” University of Medicine and Pharmacy , Cluj-Napoca , Romania
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11
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Affiliation(s)
- Radhika Dasararaju
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marisa B. Marques
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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12
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Rockenbauer L, Eichelberger B, Panzer S. Comparison of the bead-based simultaneous analysis of specific platelet antibodies assay (SASPA) and Pak Lx Luminex technology with the monoclonal antibody immobilization of platelet antigens assay (MAIPA) to detect platelet alloantibodies. ACTA ACUST UNITED AC 2015; 53:1779-83. [DOI: 10.1515/cclm-2014-1037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/17/2015] [Indexed: 11/15/2022]
Abstract
AbstractThe identification of platelet alloantibodies is indispensible for the diagnoses of fetal/neonatal alloimmune thrombocytopenia and refractoriness to platelet transfusions.We compared the results obtained with the gold-standard assay for the detection and specification of platelet antibodies, the monoclonal antibody-specific immobilization of platelet antigen assay (MAIPA), with those from two bead-based assays, simultaneous analysis of specific platelet antibodies assay (SASPA), and the recently commercialized bead-based assay Pak Lx.For the detection of alloantibodies by SASPA, the sensitivity was 94.6%, the specificity was 99.5% The respective results for Pak Lx were 98% and 99.8%. Some antibody specificities were revealed by SASPA or Pak Lx but not by MAIPA. However, there were also antibodies detected by MAIPA that were not seen by SASPA or Pak Lx. Antibody dilution experiments suggest that SASPA or Pak Lx are more sensitive than MAIPA.All three assays have limitations, but Pak Lx is suited for screening. However, other assays are necessary if results are not conclusive or for evaluations beyond the commercial assay’s design.
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13
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Basire A, Picard C. Stratégies d’exploration de l’allo-immunisation plaquettaire pour la prévention et la prise en charge des inefficacités transfusionnelles plaquettaires. Transfus Clin Biol 2014; 21:193-206. [DOI: 10.1016/j.tracli.2014.08.140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 08/28/2014] [Indexed: 12/12/2022]
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14
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Lugao RDS, Motta MP, Azevedo MFCD, Lima RGRD, Abrantes FDA, Abdala E, Carrilho FJ, Mazo DFDC. Immune thrombocytopenic purpura induced by intestinal tuberculosis in a liver transplant recipient. World J Gastroenterol 2014; 20:8304-8308. [PMID: 25009408 PMCID: PMC4081708 DOI: 10.3748/wjg.v20.i25.8304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/09/2014] [Accepted: 03/19/2014] [Indexed: 02/07/2023] Open
Abstract
A variety of clinical manifestations are associated directly or indirectly with tuberculosis. Among them, haematological abnormalities can be found in both the pulmonary and extrapulmonary forms of the disease. We report a case of immune thrombocytopenic purpura (ITP) associated with intestinal tuberculosis in a liver transplant recipient. The initial management of thrombocytopenia, with steroids and intravenous immunoglobulin, was not successful, and the lack of tuberculosis symptoms hampered a proper diagnostic evaluation. After the diagnosis of intestinal tuberculosis and the initiation of specific treatment, a progressive increase in the platelet count was observed. The mechanism of ITP associated with tuberculosis has not yet been well elucidated, but this condition should be considered in cases of ITP that are unresponsive to steroids and intravenous immunoglobulin, especially in immunocompromised patients and those from endemic areas.
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MESH Headings
- Aged
- Antitubercular Agents/therapeutic use
- Biopsy
- Colonoscopy
- Humans
- Immunocompromised Host
- Immunoglobulins, Intravenous/therapeutic use
- Immunosuppressive Agents/adverse effects
- Intestinal Diseases/diagnosis
- Intestinal Diseases/drug therapy
- Intestinal Diseases/immunology
- Intestinal Diseases/microbiology
- Liver Transplantation/adverse effects
- Male
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Purpura, Thrombocytopenic, Idiopathic/microbiology
- Steroids/therapeutic use
- Tomography, X-Ray Computed
- Treatment Outcome
- Tuberculosis, Gastrointestinal/diagnosis
- Tuberculosis, Gastrointestinal/drug therapy
- Tuberculosis, Gastrointestinal/immunology
- Tuberculosis, Gastrointestinal/microbiology
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