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Tan Y, Che L, Bi H, Fan S, Zhou Z, Min H. Clinical features and treatment effect of HIV-associated immune thrombocytopenia-single center Ten-Years data summary. Platelets 2023; 34:2200836. [PMID: 37114424 DOI: 10.1080/09537104.2023.2200836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Thrombocytopenia represents one of the most prevalent hematologic complications observed in patients infected with the human immunodeficiency virus (HIV). In this study, we sought to analyze the clinical characteristics and treatment outcomes of patients with coexisting HIV and thrombocytopenia. Specifically, we retrospectively examined the medical records of 45 patients diagnosed with HIV/AIDS and thrombocytopenia at the Yunnan Infectious Diseases Specialist Hospital between January 2010 and December 2020, all of whom received highly active antiretroviral therapy (HAART) with/without glucocorticoids. The median follow-up period was 79 days, ranging between 14 and 368 days, the total platelet count was higher after receiving treatment than before (Z = -5.662, P < .001). Among the cohort, 27 patients (60.0%) responded to treatment, with 12 patients (44.44%) experiencing relapse during the follow-up period. The response rate (80.00%) of newly diagnosed ITP were significantly higher than of persistent ITP (28.57%) and chronic ITP (38.46%) (\x 2 = 9.560, P = .008) and the relapse rate of the newly diagnosed ITP (30.00%) was significantly lower than the persistent ITP and chronic ITP (100.00%, 80.00%) (\x2 = 6.750, P = .034). Notably, we found that the number of CD4+ T cells, duration of HIV infection, selection of HAART and type of glucocorticoids administered displayed no statistically significant effect on platelet count, treatment response, or relapse rate. However, we observed a significant decrease in platelet count in hepatitis C virus-positive individuals coinfected with HIV compared to those with HIV alone (Z = -2.855, P = .003). Our findings suggest that patients diagnosed with HIV and thrombocytopenia exhibit a low response rate to treatment and have an increased likelihood of relapse.
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Affiliation(s)
- YaXian Tan
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, Chinaand
| | - Lei Che
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, Chinaand
| | - Hui Bi
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, Chinaand
| | - ShanShan Fan
- Department II of Infectious Diseases, Yunnan Infectious Diseases Specialist Hospital, Kunming, Yunnan, China
| | - ZePing Zhou
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, Chinaand
| | - HaiYan Min
- Department II of Infectious Diseases, Yunnan Infectious Diseases Specialist Hospital, Kunming, Yunnan, China
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2
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Awamura T, Nakasone ES, Gangcuangco LM, Subia NT, Bali AJ, Chow DC, Shikuma CM, Park J. Platelet and HIV Interactions and Their Contribution to Non-AIDS Comorbidities. Biomolecules 2023; 13:1608. [PMID: 38002289 PMCID: PMC10669125 DOI: 10.3390/biom13111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Platelets are anucleate cytoplasmic cell fragments that circulate in the blood, where they are involved in regulating hemostasis. Beyond their normal physiologic role, platelets have emerged as versatile effectors of immune response. During an infection, cell surface receptors enable platelets to recognize viruses, resulting in their activation. Activated platelets release biologically active molecules that further trigger host immune responses to protect the body against infection. Their impact on the immune response is also associated with the recruitment of circulating leukocytes to the site of infection. They can also aggregate with leukocytes, including lymphocytes, monocytes, and neutrophils, to immobilize pathogens and prevent viral dissemination. Despite their host protective role, platelets have also been shown to be associated with various pathophysiological processes. In this review, we will summarize platelet and HIV interactions during infection. We will also highlight and discuss platelet and platelet-derived mediators, how they interact with immune cells, and the multifaceted responsibilities of platelets in HIV infection. Furthermore, we will give an overview of non-AIDS comorbidities linked to platelet dysfunction and the impact of antiretroviral therapy on platelet function.
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Affiliation(s)
- Thomas Awamura
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (T.A.); (N.T.S.); (A.-J.B.)
| | - Elizabeth S. Nakasone
- University of Hawai‘i Cancer Center, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA;
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA;
| | - Louie Mar Gangcuangco
- Hawai‘i Center for AIDS, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (L.M.G.); (C.M.S.)
| | - Natalie T. Subia
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (T.A.); (N.T.S.); (A.-J.B.)
| | - Aeron-Justin Bali
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (T.A.); (N.T.S.); (A.-J.B.)
| | - Dominic C. Chow
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA;
- Hawai‘i Center for AIDS, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (L.M.G.); (C.M.S.)
| | - Cecilia M. Shikuma
- Hawai‘i Center for AIDS, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (L.M.G.); (C.M.S.)
| | - Juwon Park
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (T.A.); (N.T.S.); (A.-J.B.)
- Hawai‘i Center for AIDS, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (L.M.G.); (C.M.S.)
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3
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Zebardast A, Hasanzadeh A, Ebrahimian Shiadeh SA, Tourani M, Yahyapour Y. COVID-19: A trigger of autoimmune diseases. Cell Biol Int 2023; 47:848-858. [PMID: 36740221 DOI: 10.1002/cbin.11997] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/20/2022] [Accepted: 01/14/2023] [Indexed: 02/07/2023]
Abstract
The SARS-coronavirus-2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19), has spread worldwide and caused a global health emergency. SARS-CoV-2 is a coronaviridae virus that infects target cells by interacting with the plasma membrane-expressed angiotensin-converting enzyme 2 (ACE2) via the S1 component of the S protein. Effective host immune response to SARS-CoV-2 infection, which includes both innate and adaptive immunity, is critical for virus management and elimination. The intensity and outcome of COVID-19 may be related to an overabundance of pro-inflammatory cytokines, which results in a "cytokine storm" and acute respiratory distress syndrome. After SARS-CoV-2 infection, the immune system's hyperactivity and production of autoantibodies may result in autoimmune diseases such as autoimmune hemolytic anemia, autoimmune thrombocytopenia, Guillain-Barré syndrome, vasculitis, multiple sclerosis, pro-thrombotic state, and diffuse coagulopathy, as well as certain autoinflammatory conditions such as Kawasaki disease in children. We have reviewed the association between COVID-19 and autoimmune disorders in this article.
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Affiliation(s)
- Arghavan Zebardast
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hasanzadeh
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Mehdi Tourani
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Yousef Yahyapour
- Infectious Diseases & Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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4
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Zhan Y, Cao J, Ji L, Zhang M, Shen Q, Xu P, Zhuang X, Qin S, Hua F, Sun L, Li F, Chen H, Cheng Y. Impaired mitochondria of Tregs decreases OXPHOS-derived ATP in primary immune thrombocytopenia with positive plasma pathogens detected by metagenomic sequencing. Exp Hematol Oncol 2022; 11:48. [PMID: 36050760 PMCID: PMC9434515 DOI: 10.1186/s40164-022-00304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/18/2022] [Indexed: 11/11/2022] Open
Abstract
Background Primary immune thrombocytopenia (ITP) is an autoimmune disease. Some ITP patients are associated with pathogen infection undetected with conventional technologies. Investigating the changes of T cells and potential metabolic mechanism are important for better understanding of ITP. Methods The study enrolled 75 newly diagnosed ITP patients. The pathogens of patients were detected by metagenomic next-generation sequencing (mNGS). Plasma lipids were measured by liquid chromatography-mass spectrometry (LC–MS). CD4 T cell and CD8 T cell were analyzed using flow cytometry. Mitochondrial reactive oxygen species (ROS) and mitochondrial membrane potential were measured by flow cytometry. Seahorse XF real-time ATP rate assay was used to investigate the change of cellular metabolism. Results Positive plasma pathogens were detected in seven ITP patients. Of them, 5 (71.4%) positive pathogen-ITP patients were no response (NR) after first-line treatment with corticosteroids. Regulatory T cells (Tregs) increased significantly in positive pathogen-ITP patients compared to negative pathogen-ITP patients and healthy controls (HC). Mitochondrial membrane potential of Th17 and Tregs were decreased in positive pathogen-ITP and negative pathogen-ITP patients, compared to HC (all p < 0.05). The overall metabolism flux of positive pathogen-ITP patients was decreased, as compared to HC (p = 0.004), of them a higher proportion of glycolysis-derived ATP and a smaller proportion of oxidative phosphorylation (OXPHOS)-derived ATP were found in Tregs. The ATP rate index of Tregs was decreased significantly in positive pathogen-ITP patients compared to negative pathogen-ITP patients and HC (p < 0.05). Conclusions Impaired mitochondria function of Tregs in positive pathogen-ITP patients caused a decrease of OXPHOS-derived ATP and overall metabolism flux that might be the cause of steroid resistance in ITP patients.
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Affiliation(s)
- Yanxia Zhan
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Jingjing Cao
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Lili Ji
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Miaomiao Zhang
- Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Qi Shen
- Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Pengcheng Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.,Center for Tumor Diagnosis & Therapy, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Xibing Zhuang
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.,Center for Tumor Diagnosis & Therapy, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Shanshan Qin
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.,Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Fanli Hua
- Department of Hematology, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, 201700, China
| | - Lihua Sun
- Department of Hematology, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, 201700, China
| | - Feng Li
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.,Department of Hematology, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, 201700, China
| | - Hao Chen
- Department of Thoracic Surgery, Zhongshan Hospital Xuhui Branch, Fudan University, 966 Mid Huaihai Rd, Shanghai, 200031, China.
| | - Yunfeng Cheng
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China. .,Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Center for Tumor Diagnosis & Therapy, Jinshan Hospital, Fudan University, Shanghai, 201508, China. .,Department of Hematology, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, 201700, China.
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5
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Marinescu AR, Lazureanu VE, Musta VF, Nicolescu ND, Mocanu A, Cut TG, Muresan CO, Tudoran C, Licker M, Laza R. Severe Thrombocytopenic Purpura Associated with COVID-19 in a Pediatric Patient. Infect Drug Resist 2022; 15:3405-3415. [PMID: 35794926 PMCID: PMC9252296 DOI: 10.2147/idr.s363716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
Purpose Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to cause a diverse spectrum of clinical manifestations ranging from mild, flu-like symptoms to severe progressive pneumonia, acute respiratory distress syndrome with or without other extrapulmonary impairment. Hematological changes such as lymphopenia, neutrophilia, and anemia as the disease progresses, are frequently found in COVID-19. Thrombocytopenia may be drug-induced or can occur secondary to sepsis, disseminated intravascular coagulation or bone marrow suppression. Immune thrombocytopenic purpura (ITP) is frequently observed in children aged 2-5 years and in 60% of cases may proceed an upper respiratory tract infection. The present paper aimed to raise awareness of ITP as a possible pediatric presentation of coronavirus disease. Patients and Methods We present the case of previously healthy, eight-year-old female patient, who developed an immune thrombocytopenia flare, also known as immune thrombocytopenic purpura (ITP), in the context of COVID-19, with diffuse petechiae and ecchymosis on her body, face and oral mucosa, and a nadir platelet count of 0×103/μL. Results Platelet count recovery was observed after seven days of combined treatment with intravenous immunoglobulin (IVIG) and corticosteroids. Conclusion The growing body of literature regarding the clinical and laboratory manifestations of COVID-19 infection in children, has reported thrombocytopenia in relation to unfavorable disease progression or multisystem inflammatory syndrome (MIS-C). Clinicians must be aware that ITP may appear both in mild and severe COVID-19, at any time during its course, and can be associated with a higher bleeding risk, thus its diagnostic may be critical.
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Affiliation(s)
- Adelina Raluca Marinescu
- Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology, Timisoara, Romania.,Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Voichita Elena Lazureanu
- Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology, Timisoara, Romania
| | - Virgil Filaret Musta
- Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology, Timisoara, Romania
| | - Narcisa Daniela Nicolescu
- Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology, Timisoara, Romania
| | - Alexandra Mocanu
- Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology, Timisoara, Romania.,Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Talida Georgiana Cut
- Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology, Timisoara, Romania.,Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Camelia Oana Muresan
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Discipline of Forensic Medicine, Bioethics, Deontology and Medical Law, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Cristina Tudoran
- Discipline of Internal Medicine II, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Center of Molecular Research in Nephrology and Vascular Disease, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Monica Licker
- Discipline of Microbiology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Multidisciplinary Research Centre on Antimicrobial Resistance, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Ruxandra Laza
- Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology, Timisoara, Romania
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6
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Maekura C, Muramatsu A, Nagata H, Okamoto H, Onishi A, Kato D, Isa R, Fujino T, Tsukamoto T, Mizutani S, Shimura Y, Kobayashi T, Okumura K, Inaba T, Nukui Y, Kuroda J. Clinical Implication of the Effect of the Production of Neutralizing Antibodies Against SARS-Cov-2 for Chronic Immune Thrombocytopenia Flare-Up Associated with COVID-19 Infection: A Case Report and the Review of Literature. Infect Drug Resist 2022; 15:2723-2728. [PMID: 35668857 PMCID: PMC9166912 DOI: 10.2147/idr.s360238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/21/2022] [Indexed: 01/08/2023] Open
Abstract
Previous studies have demonstrated that the appropriate production of serum anti-severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) neutralizing antibody (nAb) plays a critical role in the recovery from coronavirus disease 2019 (COVID-19); however, the role of nAb production in the recovery from a flare-up of chronic immune thrombocytopenia (ITP) has been unknown. We here report the first retrospectively investigated case of serum anti-SARS-Cov-2 nAb production during chronic ITP flare-up triggered by COVID-19. A 79-year-old woman with a history of corticosteroid-refractory ITP visited our hospital complaining of fever, cough, and sore throat for 4 days. Although chronic ITP was controlled by 12.5 mg of eltrombopag (EPAG) every other day, laboratory tests showed a decreased peripheral blood platelet count of 15.0 × 109/L, which indicated worsening thrombocytopenia. Meanwhile, PCR testing of a nasopharyngeal swab revealed that the patient was positive for SARS-Cov-2, and a computed tomography scan revealed bilateral pneumonia. On the basis of the flare-up of chronic ITP associated with COVID-19 pneumonia which was determined as a moderately severe status according to the WHO clinical progression scale, intravenous immunoglobulin therapy for 5 days (days 0-4) and antiviral therapy were added on top of EPAG, which only resulted in a transient increase in the platelet count for several days. After decreasing to 8.0 × 109/L on day 13, the platelet count increased from day 16, coinciding with a positive detection for serum nAb against SARS-Cov-2. Although the increased dose up to 50 mg/day of EPAG was challenged during the clinical course, rapid dose reduction did not cause another relapse. In addition, no thrombotic or bleeding event was seen. These collectively suggest the vital role of the production of anti-SARS-Cov-2 nAb and improvement of clinical symptoms for recovery from a flare-up of chronic ITP in our case.
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Affiliation(s)
- Chika Maekura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ayako Muramatsu
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Nagata
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Haruya Okamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akio Onishi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daishi Kato
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Reiko Isa
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takahiro Fujino
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taku Tsukamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsuke Mizutani
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Blood Transfusion, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsutomu Kobayashi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keita Okumura
- Faculty of Clinical Laboratory, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tohru Inaba
- Department of Infection Control & Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoko Nukui
- Department of Infection Control & Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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7
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Bacova B, Maco M, Geislerova L, Zubata I, Kozak T, Novak J. Immune thrombocytopenia in a patient with essential thrombocythemia after SARS-CoV-2 infection: a case report. Hematol Transfus Cell Ther 2022:S2531-1379(22)00051-7. [PMID: 35494621 PMCID: PMC9042800 DOI: 10.1016/j.htct.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Barbora Bacova
- Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maria Maco
- Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Ivana Zubata
- Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Kozak
- Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Novak
- Faculty of Medicine, Charles University, Prague, Czech Republic
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8
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Abstract
Coronavirus disease 2019 (COVID-19) is still propagating a year after the start of the pandemic. Besides the complications patients face during the COVID-19 disease period, there is an accumulating body of evidence concerning the late-onset complications of COVID-19, of which autoimmune manifestations have attracted remarkable attention from the first months of the pandemic. Autoimmune hemolytic anemia, immune thrombocytopenic purpura, autoimmune thyroid diseases, Kawasaki disease, Guillain-Barre syndrome, and the detection of autoantibodies are the cues to the discovery of the potential of COVID-19 in inducing autoimmunity. Clarification of the pathophysiology of COVID-19 injuries to the host, whether it is direct viral injury or autoimmunity, could help to develop appropriate treatment.
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Affiliation(s)
- Niloufar Yazdanpanah
- Research Center for Immunodeficiencies, Children's Medical CenterTehran University of Medical SciencesTehranIran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA)Universal Scientific Education and Research Network (USERN)TehranIran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical CenterTehran University of Medical SciencesTehranIran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA)Universal Scientific Education and Research Network (USERN)TehranIran
- Department of Immunology, School of MedicineTehran University of Medical SciencesTehranIran
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9
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Wang L, Su W, Xue J, Gong X, Dai Y, Chen J, Xue L, He P, Liu Y, Tan N. Association of thrombocytopenia and infection in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. BMC Cardiovasc Disord 2021; 21:404. [PMID: 34418967 PMCID: PMC8379583 DOI: 10.1186/s12872-021-02210-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 08/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background The impact of thrombocytopenia on infection in patients with ST-elevation myocardial infarction (STEMI) remains poorly understood. Aims To evaluate the association between thrombocytopenia and infection in patients with STEMI. Methods Patients diagnosed with STEMI were identified from January 2010 to June 2016. The primary endpoint was in-hospital infection, and major adverse clinical events (MACE) and all-cause death were considered as secondary endpoints. Results A total of 1401 STEMI patients were enrolled and divided into two groups according to the presence (n = 186) or absence (n = 1215) of thrombocytopenia. The prevalence of in-hospital infection was significantly higher in the thrombocytopenic group (30.6% (57/186) vs. 16.2% (197/1215), p < 0.001). Prevalence of in-hospital MACE (30.1% (56/186) vs. 16.4% (199/1215), p < 0.001) and all-cause death (8.1% (15/186) vs. 3.8% (46/1215), p = 0.008) revealed an increasing trend. Multivariate analysis indicated that thrombocytopenia was independently associated with increased in-hospital infection (OR, 2.09; 95%CI 1.32–3.27; p = 0.001) and MACE (1.92; 1.27–2.87; p = 0.002), but not all-cause death (1.87; 0.88–3.78; p = 0.091). After a median follow-up of 2.85 years, thrombocytopenia was not associated with all-cause death at multivariable analysis (adjusted hazard ratio, 1.19; 95%CI 0.80–1.77; p = 0.383). Conclusions Thrombocytopenia is significantly correlated with in-hospital infection and MACE, and might be used as a prognostic tool in patients with STEMI. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02210-3.
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Affiliation(s)
- Litao Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China
| | - Weijiang Su
- Department of Cardiology, The People's Hospital of Dianbai District, Maoming, 525400, China
| | - Jinhua Xue
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, 341000, China
| | - Xiao Gong
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Yining Dai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Ling Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Pengcheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China. .,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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10
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Bucke D, Alizadeh K, Hallam S. COVID-19 complicated by immune thrombocytopaenic purpura and internal jugular vein thrombosis. BMJ Case Rep 2021; 14:e243680. [PMID: 34285032 PMCID: PMC8292802 DOI: 10.1136/bcr-2021-243680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 12/13/2022] Open
Abstract
A 61-year-old woman who had tested positive for COVID-19 in the community 5 days prior to admission presented with new onset severe headache and mild shortness of breath. She had an acute reduction in her platelet counts from 153×10⁹/L to 5×10⁹/L. She was diagnosed with immune thrombocytopenia purpura and after treatment with intravenous immunoglobulin, her platelet count increased to 15×10⁹/L. Due to nonresolving headache, she had a magnetic resonance venogram, which showed bilateral internal jugular vein thrombosis. She was discharged from hospital and followed up in Haematology and Neurology clinics. Her platelet count returned to normal range 7 days later. She was commenced on anticoagulation for thrombosis.
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Affiliation(s)
- Danielle Bucke
- Medicine, Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Katrin Alizadeh
- Haematology, Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Simon Hallam
- Haemato-Oncology, Barts Health NHS Trust, London, UK
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11
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McCaughan G, Di Ciaccio P, Ananda-Rajah M, Gilroy N, MacIntyre R, Teh B, Weinkove R, Curnow J, Szer J, Enjeti AK, Ross DM, Mulligan S, Trotman J, Dickinson M, Quach H, Choi P, Polizzotto MN, Tam CS, Ho PJ, Ku M, Gregory G, Gangatharan S, Hapgood G, Cochrane T, Cheah C, Gibbs S, Wei A, Johnston A, Greenwood M, Prince HM, Latimer M, Berkahn L, Wight J, Armytage T, Hamad N. COVID-19 vaccination in haematology patients: an Australian and New Zealand consensus position statement. Intern Med J 2021; 51:763-768. [PMID: 34047035 PMCID: PMC8206846 DOI: 10.1111/imj.15247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Indexed: 12/11/2022]
Abstract
Australia and New Zealand have achieved excellent community control of COVID-19 infection. In light of the imminent COVID-19 vaccination roll out in both countries, representatives from the Haematology Society of Australia and New Zealand and infectious diseases specialists have collaborated on this consensus position statement regarding COVID-19 vaccination in patients with haematological disorders. It is our recommendation that patients with haematological malignancies, and some benign haematological disorders, should have expedited access to high-efficacy COVID-19 vaccines, given that these patients are at high risk of morbidity and mortality from COVID-19 infection. Vaccination should not replace other public health measures in these patients, given that the effectiveness of COVID-19 vaccination, specifically in patients with haematological malignancies, is not known. Given the limited available data, prospective collection of safety and efficacy data of COVID-19 vaccination in this patient group is a priority.
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Affiliation(s)
- Georgia McCaughan
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Pietro Di Ciaccio
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Ananda-Rajah
- Department of Infectious Diseases, Alfred Health and Central Clinical School, Monash University, Melbourne, Victoria, Australia.,General Medical Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Nicole Gilroy
- Centre for Infectious Diseases and Clinical Microbiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Benjamin Teh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Robert Weinkove
- Wellington Blood and Cancer Centre, Capital and Coast District Health Board, Wellington, New Zealand.,Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Jennifer Curnow
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Sydney Centres for Thrombosis and Haemostasis, Sydney, New South Wales, Australia
| | - Jeff Szer
- Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Anoop K Enjeti
- NSW Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia.,Department of Haematology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,School of Medicine and Public Health Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - David M Ross
- Department of Hematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, Australia.,Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia.,Precision Medicine Theme, South Australian Health and Medical Research Institute, and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Mulligan
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Chronic Lymphocytic Leukaemia Australian Research Consortium (CLLARC), Australia
| | - Judith Trotman
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Michael Dickinson
- Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Hang Quach
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Phillip Choi
- ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia.,The National Platelet Research and Referral Centre (NPRC), Canberra, Australian Capital Territory, Australia.,Haematology Department, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Mark N Polizzotto
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Constantine S Tam
- Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - P Joy Ho
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Matthew Ku
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Gareth Gregory
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Shane Gangatharan
- Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Faculty of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Chan Cheah
- Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Department of Haematology, Pathwest Laboratory Medicine, Perth, Western Australia, Australia
| | - Simon Gibbs
- Department of Haematology, Eastern Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Wei
- Department of Clinical Hematology, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - Anna Johnston
- Department of Haematology, The Royal Hobart Hospital, Hobart, Tasmania, Australia.,Faculty of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Matthew Greenwood
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - H Miles Prince
- Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Maya Latimer
- Haematology Department, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Leanne Berkahn
- Department of Haematology, The Auckland City Hospital, Auckland, New Zealand.,Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Joel Wight
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Townsville University Hospital, Townsville, Queensland, Australia
| | - Tasman Armytage
- Department of Haematology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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12
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Misdiagnosed thrombocytopenia in children and adolescents: analysis of the Pediatric and Adult Registry on Chronic ITP. Blood Adv 2021; 5:1617-1626. [PMID: 33710335 DOI: 10.1182/bloodadvances.2020003004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/23/2021] [Indexed: 02/06/2023] Open
Abstract
Primary immune thrombocytopenia (ITP) in children is a diagnosis of exclusion, but cases of secondary ITP and nonimmune thrombocytopenia (non-IT) are generally difficult to recognize in a timely fashion. We describe a pediatric population with a revised diagnosis of secondary ITP or non-IT within 24 months of follow-up. Data were extracted from the Pediatric and Adult Registry on Chronic ITP, an international multicenter registry collecting data prospectively in patients with newly diagnosed primary ITP. Between 2004 and 2019, a total of 3974 children aged 3 months to 16 years were included. Secondary ITP and non-IT were reported in 113 patients (63 female subjects). Infectious (n = 53) and autoimmune (n = 42) diseases were identified as the main causes, with median ages at diagnosis of 3.2 years (interquartile range: 1.2; 6.7 years) and 12.4 years (interquartile range: 7.6; 13.7 years), respectively. Other causes included malignancies, aplastic anemia, immunodeficiency, and drug use. Patients with malignancy and aplastic anemia had significantly higher initial platelet counts (37 and 52 × 109/L) than did those with infection or autoimmune diseases (12 and 13 × 109/L). Characteristics of patients with secondary ITP due to infection were similar to those of children with primary ITP at first presentation, indicating similar mechanisms. Significant differences were found for age, sex, comorbidities, initial bleeding, sustained need for treatment, and disease persistence for the remaining noninfectious group compared with primary ITP. Based on our findings, we propose a diagnostic algorithm that may serve as a basis for further discussion and prospective trials.
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13
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Karcher DS. From HIV to Coronavirus Disease 2019 (COVID-19): Hematologic Complications in Viral Pandemics. Arch Pathol Lab Med 2021; 146:433-439. [PMID: 33946099 DOI: 10.5858/arpa.2021-0097-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— From the onset of the human immunodeficiency virus (HIV) pandemic in the 1980s to the recent coronavirus disease 2019 (COVID-19) pandemic, multiple viral pandemics have occurred and all have been associated with hematologic complications of varying severity. OBJECTIVE.— To review the hematologic complications associated with the HIV and other viral pandemics, the current theories regarding their causation, and the incidence and clinical impact of these complications on infected patients. DATA SOURCES.— Peer-reviewed medical literature and the author's personal experience. CONCLUSIONS.— The HIV and other viral pandemics have been associated with a variety of hematologic complications that often cause significant morbidity and mortality in affected patients. HIV infection is associated with multiple hematologic disorders, many of which have a lower incidence in the era of highly active antiretroviral therapy but still represent a major clinical problem for HIV-infected patients. Our understanding of the pathogenesis of HIV-related hematologic complications, including HIV-associated lymphoproliferative disorders, has evolved in recent years. Other viral pandemics, including H1N1 influenza, severe acute respiratory syndrome (SARS) coronavirus, Middle East respiratory syndrome (MERS) coronavirus, and COVID-19, have also been associated with hematologic complications of varying severity. Our emerging understanding of the pathogenesis of the hematologic complications of HIV, COVID-19, and other viral pandemics may help in prevention, correct diagnosis, and treatment of these complications in current and future pandemics.
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Affiliation(s)
- Donald S Karcher
- From the Department of Pathology, George Washington University Medical Center, Washington, District of Columbia
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14
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Aydın FY, Demircan V. Diagnosis and management of coronavirus disease-associated immune thrombocytopenia: a case series. Rev Soc Bras Med Trop 2021; 54:e0029 2021. [PMID: 33950122 PMCID: PMC8083887 DOI: 10.1590/0037-8682-0029-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
Data on health problems and fatal complications associated with coronavirus disease (COVID-19) have consistently been reported. Although immune thrombocytopenia has been associated with multiple viral infections, only few studies have shown its association with COVID-19. Here, we have reported a case series of two cases pertaining to patients diagnosed with COVID-19-associated immune thrombocytopenia, elaborating on the clinical course, management, and response to treatment.
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Affiliation(s)
- Fatma Yılmaz Aydın
- University of Dicle, School of Medicine, Department of Internal Medicine, Diyarbakır, Turkey
| | - Vehbi Demircan
- University of Dicle, School of Medicine, Department of Hematology, Diyarbakır, Turkey
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15
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Kocak MZ, Aktas G, Bilgin S, Duman TT, Kurtkulagi O, Atak B, Demirkol ME, Yilmaz EB. An unusual immune thrombocytopenia case associated with dietary supplements containing 3G (Green tea, Ginseng and Guarana). RUSSIAN OPEN MEDICAL JOURNAL 2020; 9. [DOI: 10.15275/rusomj.2020.0307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023] Open
Abstract
Immune thrombocytopenia (ITP) is caused by autoantibodies to platelet antigens. Ginseng, a herbal remedy, inhibits platelet aggregation as well as green tea and guarana. We present a case of secondary ITP due to food supplement that contains ginseng, guarana and green tea, which is not previously reported in medical literature. A 39-year-old man was admitted to our clinic because of 2 days history of oral mucosal hemorrhage and recently developed skin lesions on extensor surfaces of bilateral upper extremity and both ankles. Platelet count was 5,470/mm3. He was diagnosed with secondary ITP, possibly due to herbal supplement contained green tea, ginseng and guarana, which patient was received for 4-5 days about 1 month ago. He responded well to the treatment with methyl prednisolone. Since herbal medicines and dietary supplements have many toxic effects it should be kept in mind that secondary ITP may develop during supplementation with these herbal products.
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16
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Thadchanamoorthy V, Dayasiri K. Dengue hemorrhagic fever as a rare cause of chronic immune thrombocytopenic purpura-a pediatric case report. Trop Med Health 2020; 48:59. [PMID: 32699523 PMCID: PMC7370471 DOI: 10.1186/s41182-020-00248-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Dengue is a common mosquito-borne infection in tropical countries. Dengue incidence in Sri Lanka is generally showing a rising trend. Both chronic immune thrombocytopenia purpura (ITP) children and chronic ITP triggered by dengue fever in the pediatric age group are rarely reported. This unusual presentation is a diagnostic challenge to clinicians. The authors have reported a pediatric patient who presented with chronic ITP following recovery from dengue hemorrhagic fever. Case presentation A 14-year-old previously healthy boy was initially managed as for dengue hemorrhagic fever. Following initial detection of persistent thrombocytopenia at 2 weeks post-discharge, his parents defaulted follow-up for 1 year as he remained asymptomatic. However, 1 year after initial admission, the child re-presented with ecchymotic patches and a platelet count of 30 × 103/cumm. Review of serial blood counts performed during previous hospital admission and by his parents themselves revealed persistent thrombocytopenia over preceding 12 months. Subsequently, the child had an in-depth evaluation. The diagnosis of ITP was confirmed by ruling out differential diagnosis and he was managed as for chronic ITP. His platelet counts showed good response to oral corticosteroids and he is currently being followed up at the pediatric hematology clinic. Conclusion While reporting, a 14-year-old boy who developed chronic ITP following dengue hemorrhagic fever, this report highlights importance of frequent monitoring of blood counts to accurately detect and manage critical phase of dengue fever. The report also highlights the value of monitoring platelet counts in post-recovery phase to ensure they have normalized.
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Affiliation(s)
- V Thadchanamoorthy
- Faculty of Health Care Sciences, Eastern University, Chenkalady, Sri Lanka
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17
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Hindilerden F, Yonal-Hindilerden I, Sevtap S, Kart-Yasar K. Immune Thrombocytopenia in a Very Elderly Patient With Covid-19. Front Med (Lausanne) 2020; 7:404. [PMID: 32754609 PMCID: PMC7365892 DOI: 10.3389/fmed.2020.00404] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023] Open
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a decreased number of platelets and mucocutaneous bleeding. Many viruses have been identified as triggers of the autoimmune process, including human immunodeficiency virus (HIV), hepatitis C virus (HCV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus, rubella, and measles. Association with the new severe acute respiratory syndrome coronavirus, SARS-CoV-2 infection (Covid-19 infection) has been rarely reported. Here, we report the oldest case of ITP patient triggered by the novel coronavirus infection. He showed inadequate response to IVIG but responded to corticosteroids with no severe adverse events. Further studies are warranted to determine the optimal therapeutic strategies for ITP with the Covid-19 infection.
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Affiliation(s)
- Fehmi Hindilerden
- Hematology Clinic, Bakirköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ipek Yonal-Hindilerden
- Division of Hematology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Senoglu Sevtap
- Department of Microbiology and Infectious Diseases, Bakirköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kadriye Kart-Yasar
- Department of Microbiology and Infectious Diseases, Bakirköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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18
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Lévesque V, Millaire É, Corsilli D, Rioux-Massé B, Carrier FM. Severe immune thrombocytopenic purpura in critical COVID-19. Int J Hematol 2020; 112:746-750. [PMID: 32613314 PMCID: PMC7327458 DOI: 10.1007/s12185-020-02931-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Abstract
COVID-19 is a new disease with many undescribed clinical manifestations. We report herein a case of severe immune thrombocytopenic purpura (ITP) in a critical COVID-19 patient. A patient presented a severe episode of immune thrombocytopenia (< 10 × 109/L) 20 days after admission for a critical COVID-19. This thrombocytopenia was associated with a life-threatening bleeding. Response to first-line therapies was delayed as it took up to 13 days after initiation of intravenous immunoglobulin and high-dose dexamethasone to observe an increase in platelet count. COVID-19 may be associated with late presenting severe ITP. Such ITP may also be relatively resistant to first-line agents. Hematological manifestations of COVID-19, such as the ones associated with life-threatening bleeding, must be recognized.
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Affiliation(s)
- Valérie Lévesque
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Émilie Millaire
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Daniel Corsilli
- Department of Medicine - Critical Care Division, Centre hospitalier de I'Université de Montréal, Montréal, Canada
| | - Benjamin Rioux-Massé
- Department of Medicine - Hematology Division, Centre hospitalier de I'Université de Montréal, Montréal, Canada
| | - François-Martin Carrier
- Department of Medicine - Critical Care Division, Centre hospitalier de I'Université de Montréal, Montréal, Canada. .,Department of Medicine - Hematology Division, Centre hospitalier de I'Université de Montréal, Montréal, Canada. .,Department of Anesthesiology, Centre hospitalier de I'Université de Montréal, Montréal, Canada. .,Carrefour de I'Innovation, Centre de recherche du Centre hospitalier de I'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montréal, QC, H2X 0A9, Canada.
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19
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Rawi S, Wu GY. Pathogenesis of Thrombocytopenia in Chronic HCV Infection: A Review. J Clin Transl Hepatol 2020; 8:184-191. [PMID: 32832399 PMCID: PMC7438357 DOI: 10.14218/jcth.2020.00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/12/2022] Open
Abstract
A large proportion of patients with chronic hepatitis C have associated thrombocytopenia (TCP). Due to bleeding risks, TCP, when severe, can limit diagnostic and therapeutic procedures, treatments, and increases risk of complications, especially excessive bleeding. It is important to understand the mechanisms that cause TCP in order to manage it. In general, TCP can be due to increased destruction or decreased production. Proposed mechanisms of increased destruction include autoantibodies to platelets and hypersplenism with sequestration. Proposed mechanisms of decreased production include virus-induced bone marrow suppression and decreased TPO production. Autoantibodies directed against platelet surface antigens have demonstrated an inverse correlation with platelet counts. Hypersplenism with sequestration involves the interaction of portal hypertension, splenomegaly, and platelet destruction. Decreased production mechanisms involve appropriate and inappropriate levels of TPO secretion. There is limited evidence to support viral-induced bone marrow suppression. In contrast, there is strong evidence to support low levels of TPO in liver failure as a major cause of TCP. TPO-agonists, specifically eltrombopag, have been shown in hepatitis C patients to increase platelet counts without reducing portal hypertension or splenomegaly. We conclude that TCP in hepatitis C virus-induced liver disease is often multifactorial, but an understanding of the mechanisms can lead to judicious use of new drugs for treatment.
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Affiliation(s)
- Sarah Rawi
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- Correspondence to: Sarah Rawi, Department of Medicine, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06032, USA. Tel: +1-858-692-2372, E-mail:
| | - George Y Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
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20
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Idiopathic thrombocytopenic purpura (ITP) - new era for an old disease. ACTA ACUST UNITED AC 2020; 57:273-283. [PMID: 31199777 DOI: 10.2478/rjim-2019-0014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia is an autoimmune hematological disorder characterized by severely decreased platelet count of peripheral cause: platelet destruction via antiplatelet antibodies which may also affect marrow megakaryocytes. Patients may present in critical situations, with cutaneous and/or mucous bleeding and possibly life-threatening organ hemorrhages (cerebral, digestive, etc.) Therefore, rapid diagnosis and therapeutic intervention are mandatory. Corticotherapy represents the first treatment option, but as in any autoimmune disorder, there is a high risk of relapse. Second line therapy options include: intravenous immunoglobulins, thrombopoietin receptor agonists, rituximab or immunosuppression, but their benefit is usually temporary. Moreover, the disease generally affects young people who need repeated and prolonged treatment and hospitalization and therefore, it is preferred to choose a long term effect therapy. Splenectomy - removal of the site of platelet destruction - represents an effective and stable treatment, with 70-80% response rate and low complications incidence. A challenging situation is the association of ITP with pregnancy, which further increases the risk due to the immunodeficiency of pregnancy, major dangers of bleeding, vital risks for mother and fetus, potential risks of medication, necessity of prompt intervention in the setting of specific obstetrical situations - delivery, pregnancy loss, obstetrical complications, etc. We present an updated review of the current clinical and laboratory data, as well as a detailed analysis of the available therapeutic options with their benefits and risks, and also particular associations (pregnancy, relapsed and refractory disease, emergency treatment).
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21
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HIV infection and its effects on the development of autoimmune disorders. Pharmacol Res 2018; 129:1-9. [DOI: 10.1016/j.phrs.2018.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 01/05/2023]
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22
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Geletaw T, Tadesse MZ, Demisse AG. Hematologic abnormalities and associated factors among HIV infected children pre- and post-antiretroviral treatment, North West Ethiopia. J Blood Med 2017; 8:99-105. [PMID: 28831276 PMCID: PMC5552149 DOI: 10.2147/jbm.s137067] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There are few studies on the hematologic parameters of HIV-infected individuals in Ethiopia; of these, almost all studies researched adults. Our current study is unique in that it mainly focused on the pediatric population and compared both pre- and post-antiretroviral therapy (ART) children. Inference from this study can be used for other developing countries where the burden of HIV disease is high. OBJECTIVE The aim of this study was to identify hematologic abnormalities in HIV-infected children before and after initiation of ART. METHODOLOGY A cross-sectional study was conducted on HIV-infected children from June 1 to August 30, 2015. Data were collected using a pretested and structured questionnaire. Statistical analysis was performed using SPSS 20 version. RESULTS The median age of study subjects was 10 years with an interquartile range (IQR) of (6, 12). Two-thirds (74.3%) of study subjects received ART for >1 year. The median of CD4 count before ART was 490 cells/mm3 with an IQR of (286, 765); this increased to 663 cells mm3 with an IQR of (499, 908) after ART. Likewise, the median of hemoglobin before ART was 11.5 mg/dL with an IQR of (9.9, 13), which increased after ART to 13 mg/dL with an IQR of (11.8, 14). The prevalence of anemia was 42.8% before and 18.9% after ART initiation. The median of absolute neutrophil count before ART was 3×103 with an IQR of (2.1, 4.6) and after ART, it became 3×103 with IQR of (1.9, 4.2). Age <5 years (adjusted odds ratio [AOR]: 2.76; 95% CI: 1.5, 5.0), an advanced stage of AIDS (AOR: 2.8; 95% CI: 1.4, 5.6) and CD4% <25% (AOR: 2.4; 95% CI: 1.2, 4.9) were significantly associated with anemia before ART initiation, while opportunistic infections were associated with anemia after initiation of ART (AOR: 2.3; 95% CI: 1.08, 4.8). CONCLUSION ART positively or negatively affects the hematologic profile of HIV-infected children. The current study demonstrated a significant reduction of anemia after initiation of ART.
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Affiliation(s)
- Teshome Geletaw
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Meseret Zelalem Tadesse
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Abayneh Girma Demisse
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Science, University of Gondar, Ethiopia
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Audia S, Mahévas M, Samson M, Godeau B, Bonnotte B. Pathogenesis of immune thrombocytopenia. Autoimmun Rev 2017; 16:620-632. [DOI: 10.1016/j.autrev.2017.04.012] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 03/17/2017] [Indexed: 01/19/2023]
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Tsegay YG, Tadele A, Addis Z, Alemu A, Melku M. Magnitude of cytopenias among HIV-infected children in Bahir Dar, northwest Ethiopia: a comparison of HAART-naïve and HAART-experienced children. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2017; 9:31-42. [PMID: 28260948 PMCID: PMC5325102 DOI: 10.2147/hiv.s125958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background AIDS, caused by HIV, is a multisystem disease that affects hematopoiesis. The aim of this study was to assess cytopenias among HIV-infected children who had a follow-up at Felege Hiwot Referral Hospital, Bahir Dar, northwest Ethiopia. Methods An institution-based cross-sectional study was conducted between April and May 2013. Systematic random sampling method was used to select the study participants. Descriptive statistics, independent t-test as well as chi-square and logistic regression were used for analysis. A p-value <0.05 was considered as statistically significant. Results A total of 224 children (112 highly active antiretroviral therapy [HAART]-naïve and 112 HAART-experienced) participated in the study. The magnitude of anemia, thrombocytopenia, neutropenia, leukopenia and pancytopenia among HAART-naïve HIV-infected children were 30.4%, 9.8%, 8%, 4.5% and 1.8%, respectively. The overall prevalence of anemia, neutropenia, thrombocytopenia, leukopenia and pancytopenia were 29.5%, 8.9%, 8%, 4.5% and 1.4%, respectively. Cluster of differentiation-4 percentage and mean corpuscular volume were significantly different between HAART-experienced and HAART-naïve children. Being of younger age and severely immunosuppressed were risk factors of anemia. Conclusion Anemia was the most common cytopenia, followed by neutropenia. Severe immunosuppression and younger age were significantly associated with anemia. Therefore, emphasis should be given for investigation and management of cytopenias in HIV-infected children, particularly for those who are immunosuppressed and of younger age.
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Affiliation(s)
| | | | | | - Agersew Alemu
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abstract
Virus–platelet interplay is complex. Diverse virus types have been shown to associate with numerous distinct platelet receptors. This association can benefit the virus or the host, and thus the platelet is somewhat of a renegade. Evidence is accumulating to suggest that viruses are capable of entering platelets. For at least one type of RNA virus (dengue virus), the platelet has the necessary post-translational and packaging machinery required for production of replicative viral progeny. As a facilitator of immunity, the platelet also participates in eradicating the virus by direct and indirect mechanisms involving presentation of the pathogen to the innate and adaptive immune systems, thus enhancing inflammation by release of cytokines and other agonists. Virus-induced thrombocytopenia is caused by tangential imbalance of thrombopoeisis, autoimmunity, and loss of platelet function and integrity.
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Virot E, Duclos A, Adelaide L, Miailhes P, Hot A, Ferry T, Seve P. Autoimmune diseases and HIV infection: A cross-sectional study. Medicine (Baltimore) 2017; 96:e5769. [PMID: 28121924 PMCID: PMC5287948 DOI: 10.1097/md.0000000000005769] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To describe the clinical manifestations, treatments, prognosis, and prevalence of autoimmune diseases (ADs) in human immunodeficiency virus (HIV)-infected patients.All HIV-infected patients managed in the Infectious Diseases Department of the Lyon University Hospitals, France, between January 2003 and December 2013 and presenting an AD were retrospectively included.Thirty-six ADs were found among 5186 HIV-infected patients which represents a prevalence of 0.69% including immune thrombocytopenic purpura (n = 15), inflammatory myositis (IM) (n = 4), sarcoidosis (n = 4), Guillain-Barré syndrome (GBS) (n = 4), myasthenia gravis (n = 2), Graves' disease (n = 2), and 1 case of each following conditions: systemic lupus erythematosus, rheumatoid arthritis, autoimmune hepatitis, Hashimoto thyroiditis and autoimmune hemolytic anemia. One patient presented 2 ADs. Thirty patients were known to be HIV-infected when they developed an AD. The AD preceded HIV infection in 2 patients. GBS and HIV infection were diagnosed simultaneously in 3 cases. At AD diagnosis, CD4 T lymphocytes count were higher than 350/mm in 63% of patients, between 200 and 350/mm in 19% and less than 200/mm in 19%. Twenty patients benefited from immunosuppressant treatments, with a good tolerance.ADs during HIV infection are uncommon in this large French cohort. Immune thrombocytopenic purpura, sarcoidosis, IM, and GBS appear to be more frequent than in the general population. Immunosuppressant treatments seem to be effective and well tolerated.
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Affiliation(s)
- Emilie Virot
- Département de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Antoine Duclos
- Pôle Information Médicale Evaluation Recherche des Hospices Civils de Lyon
| | - Leopold Adelaide
- Département de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Patrick Miailhes
- Département de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Arnaud Hot
- Université de Lyon, Université Lyon 1
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Département de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon
- Université de Lyon, Université Lyon 1
| | - Pascal Seve
- Département de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon
- Université de Lyon, Université Lyon 1
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Abstract
INTRODUCTION Acquired thrombocytopenia recognizes a myriad of causes. Among these, infectious diseases play a relevant role since a low platelet count is commonplace along with other abnormal laboratory data. Areas covered: This narrative review, after a brief presentation of the possible pathogenic mechanisms, is focused on the most prevalent infections associated with thrombocytopenia, namely those attributable to hepatitis C virus (HCV), human immunodeficiency virus (HIV) and Helicobacter pylori. Expert commentary: An underlying HCV or HIV infection should always be suspected in patients at risk who present with isolated thrombocytopenia. The eradication of Helicobacter pylori is advisable in infected patients with secondary immune thrombocytopenia, because this will increase the platelet count in a substantial number of cases, thus avoiding more aggressive and prolonged treatments.
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Affiliation(s)
- Massimo Franchini
- a Department of Hematology and Transfusion Medicine , Carlo Poma Hospital , Mantova , Italy
| | - Dino Veneri
- b Department of Medicine, Section of Haematology , University of Verona , Verona , Italy
| | - Giuseppe Lippi
- c Section of Clinical Biochemistry , University of Verona , Verona , Italy
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Moukhadder HM, Chaya BF, Bazarbachi AHA, Taher AT. Immune thrombocytopenia: a comprehensive review from pathophysiology to promising treatment modalities. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1247691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Xu J, Zhao L, Zhang Y, Guo Q, Chen H. CD16 and CD32 Gene Polymorphisms May Contribute to Risk of Idiopathic Thrombocytopenic Purpura. Med Sci Monit 2016; 22:2086-96. [PMID: 27315784 PMCID: PMC4915321 DOI: 10.12659/msm.895390] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Epidemiological studies have evaluated the associations of CD16 158F>V and CD32 131H>R gene polymorphisms with the risk of idiopathic thrombocytopenic purpura (ITP). MATERIAL AND METHODS Published studies on CD16 158F>V and CD32 131H>R polymorphisms with susceptibility to ITP were systematically reviewed until April 1, 2014. The Cochrane Library Database, Medline, CINAHL, EMBASE, Web of Science, and Chinese Biomedical Database (CBM) were used to search for relevant studies and then a meta-analysis was conducted by using Stata 12.0 software in order to produce consistent statistical results. RESULTS In total, 10 clinical case-control studies with 741 ITP patients and 1092 healthy controls were enrolled for quantitative data analysis. Results of this meta-analysis suggest that CD16 158F>V polymorphism had strong correlations with the susceptibility to ITP under 5 genetic models (all P<0.05). However, no similar associations were found between CD32 131H>R polymorphism and the susceptibility to ITP (all P>0.05). Subgroup analysis by ethnicity revealed that CD16 158F>V polymorphism was associated with the increased risk of ITP among both Caucasian and non-Caucasian populations. Nevertheless, no statistically significant correlations between CD32 131H>R polymorphism and the risk of ITP were observed among Caucasians and non-Caucasians (all P>0.05). CONCLUSIONS Our findings indicate that CD16 158F>V polymorphism may contribute to the increased risk of ITP, whereas CD32 131H>R polymorphism may not be an important risk factor for ITP.
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Affiliation(s)
- Jiannan Xu
- Department of Cardiology, Yanjiao People's Hospital, Sanhe, Hebei, China (mainland)
| | - Liyun Zhao
- Department of Hematology, Xingtai People's Hospital, Xingtai, Hebei, China (mainland)
| | - Yan Zhang
- Department of Ophthalmology, The Military General Hospital of Beijing PLA, Beijing, China (mainland)
| | - Qingxu Guo
- Department of Vascular Surgery, The Military General Hospital of Beijing PLA, Beijing, China (mainland)
| | - Hui Chen
- Department of Hematology, The Military General Hospital of Beijing PLA, Beijing, China (mainland)
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Sokalski KM, Chu J, Mai AY, Qiu AQ, Albert AYK, Zanet DL, Côté HCF, Maan EJ, Pick N, Prior JC, Money DM, Murray MCM. Endocrine abnormalities in HIV-infected women are associated with peak viral load - the Children and Women: AntiRetrovirals and Markers of Aging (CARMA) Cohort. Clin Endocrinol (Oxf) 2016; 84:452-62. [PMID: 26300027 DOI: 10.1111/cen.12881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/31/2015] [Accepted: 08/14/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate the prevalence of endocrine disturbances in a group of HIV-positive (HIV+) women and to identify factors affecting presence of these disorders. To examine specifically whether cellular ageing, as measured by leukocyte telomere length (LTL), is correlated with the presence of endocrine disturbance. DESIGN A cross-sectional retrospective substudy of an ongoing prospective cohort study. PATIENTS Adult HIV+ (≥19 years) women enrolled in the CARMA (Children and Women: AntiRetrovirals and Markers of Aging) cohort study (N = 192). Prevalences of T2DM, glucose intolerance, dyslipidaemia, thyroid disorders, adrenal insufficiency, hypogonadism, primary ovarian insufficiency (POI), demographics, HIV and hepatitis C virus (HCV) infection status, baseline LTL, combined antiRetroviral therapy (cART) and substance exposures were collected. Statistical analysis included univariable followed by multivariable Poisson regression and step-wise reduction to refine the multivariable model. RESULTS Prevalence of any endocrine abnormality was 58% (dyslipidaemia 43%, glucose intolerance/T2DM 13%, thyroid disorders 15%). In multivariable analysis, age was associated with number and type (any, glucose, lipid) of abnormality, while increasing body mass index (BMI) was associated with number of diagnoses and with glucose metabolism disorders. Interestingly, peak HIV pVL ≥100 000 copies/ml was associated with any abnormality, total number of disorders and presence of a thyroid disorder, while any disorder, glucose abnormalities and dyslipidaemia were negatively associated with alcohol use. LTL was not associated with number or type of endocrine abnormalities in this study. CONCLUSION Further studies examining the relationship between duration and extent of exposure to HIV viraemia in relation to developing abnormal endocrine function are warranted.
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Affiliation(s)
- Kristen M Sokalski
- Department of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Jackson Chu
- Department of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Alice Y Mai
- Department of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Annie Q Qiu
- Department of Biochemistry and Molecular Biology, UBC, Vancouver, BC, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | | | - DeAnna L Zanet
- Department of Pathology & Laboratory Medicine, UBC, Vancouver, BC, Canada
| | - Hélène C F Côté
- Women's Health Research Institute, Vancouver, BC, Canada
- Department of Pathology & Laboratory Medicine, UBC, Vancouver, BC, Canada
| | - Evelyn J Maan
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Disease, UBC, Vancouver, BC, Canada
| | - Jerilynn C Prior
- Department of Medicine, Division of Endocrinology, Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
| | - Deborah M Money
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, UBC, Vancouver, BC, Canada
| | - Melanie C M Murray
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Disease, UBC, Vancouver, BC, Canada
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Horino T, Sato F, Kato T, Hosaka Y, Shimizu A, Kawano S, Hoshina T, Nakaharai K, Nakazawa Y, Yoshikawa K, Yoshida M, Hori S. Associations of HIV testing and late diagnosis at a Japanese university hospital. Clinics (Sao Paulo) 2016; 71:73-7. [PMID: 26934235 PMCID: PMC4760363 DOI: 10.6061/clinics/2016(02)04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/08/2015] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES This study was conducted to clarify the rate of late diagnosis of HIV infection and to identify relationships between the reasons for HIV testing and a late diagnosis. METHODS This retrospective cohort study was conducted among HIV-positive patients at the Jikei University Hospital between 2001 and 2014. Patient characteristics from medical records, including age, sex, sexuality, the reason for HIV testing and the number of CD4-positive lymphocytes at HIV diagnosis, were assessed. RESULTS A total of 459 patients (men, n=437; 95.2%) were included in this study and the median age at HIV diagnosis was 36 years (range, 18-71 years). Late (CD4 cell count <350/mm3) and very late (CD4 cell count <200/mm3) diagnoses were observed in 61.4% (282/459) and 36.6% (168/459) of patients, respectively. The most common reason for HIV diagnosis was voluntary testing (38.6%, 177/459 patients), followed by AIDS-defining illness (18.3%, 84/459 patients). Multivariate analysis revealed a significant association of voluntary HIV testing with non-late and non-very-late diagnoses and there was a high proportion of AIDS-defining illness in the late and very late diagnosis groups compared with other groups. Men who have sex with men was a relative factor for non-late diagnosis, whereas nonspecific abnormal blood test results, such as hypergammaglobulinemia and thrombocytopenia, were risk factors for very late diagnosis. CONCLUSIONS Voluntary HIV testing should be encouraged and physicians should screen all patients who have symptoms or signs and particularly hypergammaglobulinemia and thrombocytopenia, that may nonspecifically indicate HIV infection.
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Flores-Chang BS, Arias-Morales CE, Wadskier FG, Gupta S, Stoicea N. Immune Thrombocytopenic Purpura Secondary to Cytomegalovirus Infection: A Case Report. Front Med (Lausanne) 2015; 2:79. [PMID: 26579523 PMCID: PMC4630589 DOI: 10.3389/fmed.2015.00079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/20/2015] [Indexed: 11/13/2022] Open
Abstract
Immune thrombocytopenic purpura (ITP) is defined as an acquired thrombocytopenia with antibodies detected against platelet surface antigens, and it is the most common form of thrombocytopenia in otherwise asymptomatic adults. ITP secondary to an underlying condition is a diagnosis of exclusion that is essential to establish for treatment efficacy. Secondary thrombocytopenia caused by cytomegalovirus (CMV) is common; however, case reports associated with diagnosis in immunocompetent adults are rare, and to the best of our knowledge only 20 publications have been associated with this diagnosis. Our report is based on a clinical presentation of a 37-year-old female complaining of petechiae, heavy menses, shortness of breath, and a platelet count of 1 × 109/L. Treatment with IVIG and steroids failed to improve platelet count. Subsequently, an infectious laboratory workup was performed, detecting CMV infection, and treatment with antiviral agents was initiated, causing platelet count to increase as viral load decreased.
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Affiliation(s)
| | - Carlos E Arias-Morales
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Francis G Wadskier
- Department of Internal Medicine, St. Barnabas Hospital Bronx , Bronx, NY , USA
| | - Sorab Gupta
- Department of Internal Medicine, St. Barnabas Hospital Bronx , Bronx, NY , USA
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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Korolevskaya LB, Shmagel KV, Shmagel NG. Characteristics of Circulating Immune Complexes in HIV-Infected Patients with Different Viral Load. Bull Exp Biol Med 2015; 159:469-71. [PMID: 26388572 DOI: 10.1007/s10517-015-2994-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Indexed: 10/23/2022]
Abstract
Serum concentration of antiviral antibodies was measured in HIV-infected patients with different viral load. It was found that higher concentrations of HIV-antigens correspond to higher titer of antiviral antibodies. Circulating immune complexes were isolated from patients' serum to estimate their size and immunoglobulin composition. High levels of small IgG- and IgM-containing complexes were identified in HIV-infected patients. In patients receiving antiretroviral treatment, the content of these complexes was significantly lower than in patients with high HIV load. This attests to positive role of specific therapy in preventing immune complex-associated pathology in HIV patients.
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Affiliation(s)
- L B Korolevskaya
- Institute of Ecology and Genetics of Microorganisms, Ural Division of the Russian Academy of Sciences, Ekaterinburg, Russia. .,Regional Center on Prophylaxis and Combating of AIDS and Infection Diseases, Perm', Russia.
| | - K V Shmagel
- Institute of Ecology and Genetics of Microorganisms, Ural Division of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - N G Shmagel
- Regional Center on Prophylaxis and Combating of AIDS and Infection Diseases, Perm', Russia
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Enawgaw B, Alem M, Addis Z, Melku M. Determination of hematological and immunological parameters among HIV positive patients taking highly active antiretroviral treatment and treatment naïve in the antiretroviral therapy clinic of Gondar University Hospital, Gondar, Northwest Ethiopia: a comparative cross-sectional study. BMC HEMATOLOGY 2014; 14:8. [PMID: 24666771 PMCID: PMC3994311 DOI: 10.1186/2052-1839-14-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 03/19/2014] [Indexed: 11/28/2022]
Abstract
Background Anemia, leucopenia and thrombocytopenia are the commonest hematological abnormalities resulting from human immunodeficiency virus infection. The use of antiretroviral drugs could positively or negatively affect these disorders. Thus a specific diagnosis and a determination of hematological and immunological parameters are required for initiating and monitoring early treatment to avert disease progression. Therefore, this study aimed to compare hematological and immunological parameters in HIV positive patients taking antiretroviral therapy and those treatment naïve patients in Gondar University Hospital. Methods A comparative cross-sectional study was conducted on a total of 290 HIV patients from February to May 2012 in Gondar University Hospital. Study subjects were divided in to two groups: 145 HIV positive treatment naïve and 145 on HAART. Data of socio demographic characteristics and clinical conditions of the study subjects was collected using structured pretested questionnaire at their follow up date. Hematological and immunological parameters were collected and processed by cell Dyne 1800 and BD FACS count respectively. The variables compared here were Hematological parameters (Total and differential WBC, RBC, Hgb, HCT, MCV, MCH, MCHC, RDW, PLT, and MPV) and CD4 count. In order to compare means independent sample T-test was conducted using SPSS version 20 statistical software. P- Value < 0.05 was considered as significant. Result Prevalence of anemia, leucopenia, thrombocytopenia, neutropenia and lymphopenia were 11.7%, 35.9%, 4.1%, 28.3% and 2.1% in patients on HAART and 29.7%, 16.6%, 9%, 14.5% and 2.1% in HAART naïve patients respectively. There was a significant difference in total WBC, RBC, Hgb, MCV, MCH, MCHC, MPV and CD4 counts between patients on HAART and HAART naïve patients. Conclusion Prevalence of anemia was high in HAART naïve patients while leucopenia and neutropenia prevalence was higher in patients on HAART and their prevalence increased as the CD4 count decreased. HIV Patients should be investigated for hematological and immunological changes following with appropriate therapeutic interventions.
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Affiliation(s)
- Bamlaku Enawgaw
- Department of Hematology & Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P,O, Box 196, Gondar, Ethiopia.
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Lebano R, Rosato V, Masarone M, Romano M, Persico M. The effect of antiviral therapy on hepatitis C virus-related thrombocytopenia: a case report. BMC Res Notes 2014; 7:59. [PMID: 24457056 PMCID: PMC3915622 DOI: 10.1186/1756-0500-7-59] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 01/20/2014] [Indexed: 12/22/2022] Open
Abstract
Background Autoimmune thrombocytopenic purpura is an immunological disorder characterized by increased platelet destruction due to presence of anti-platelet autoantibodies. Hepatitis C virus infection, which is one of the most common chronic viral infections worldwide, may cause secondary chronic immune thrombocytopenic purpura. Case presentation We report a case of a 51-year-old Caucasian female with hepatitis C virus infection who developed a severe, reversible, immune thrombocytopenia. Platelet count was as low as 56.000/mm3, hepatitis C virus serology was positive, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and gamma-glutamyltransferase serum levels were elevated. Disorders potentially associated with autoimmune thrombocytopenic purpura were ruled out. A corticosteroid treatment was started and led to an increase in platelet count. The patient was then treated with pegylated-interferon alpha 2a and ribavirin. After four weeks of treatment hepatitis C virus - ribonucleic acid became undetectable and steroid treatment was discontinued. Six months of antiviral therapy achieved a sustained biochemical and virological response together with persistence of normal platelet count. Conclusion In our case report hepatitis C virus seemed to play a pathogenic role in autoimmune thrombocytopenic purpura. Moreover, the successful response (negative hepatitis C virus - ribonucleic acid) to tapered steroids and antiviral therapy was useful to revert thrombocytopenia.
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Affiliation(s)
| | | | | | | | - Marcello Persico
- Department of Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy.
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Sajwani F, Al Tunaiji H. Demographic and clinical analysis on hospitalized patients with thrombocytopenia. JOURNAL OF APPLIED HEMATOLOGY 2014. [DOI: 10.4103/1658-5127.137147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Immune thrombocytopenia (ITP) is a common hematologic disorder characterized by isolated thrombocytopenia. ITP presents as a primary or a secondary form. ITP may affect individuals of all ages, with peaks during childhood and in the elderly, in whom the age-specific incidence of ITP is greatest. Bleeding is the most common clinical manifestation of ITP. The pathogenesis of ITP is complex, involving alterations in humoral and cellular immunity. Corticosteroids remain the most common first line therapy for ITP. This article summarizes the classification and diagnosis of primary and secondary ITP, as well as the pathogenesis and options for treatment.
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Affiliation(s)
- Gaurav Kistangari
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
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Vaughan J, Wiggill T, Munster M. Immature platelet fraction levels in a variety of bone marrow pathologies in South African HIV-positive patients with thrombocytopenia. ACTA ACUST UNITED AC 2013; 19:417-23. [PMID: 24295040 DOI: 10.1179/1607845413y.0000000143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Thrombocytopenia is common in HIV-infected individuals and often requires a diagnostic bone marrow examination. Interpretation may, however, be limited due to the multifactorial nature of HIV-associated thrombocytopenia and the difficulty in assessing megakaryocyte function morphologically. The immature platelet fraction (IPF) is a parameter which reportedly reflects megakaryocyte activity, with an IPF >7.7% suggesting increased platelet production. The aim of this study was to correlate the IPF with the bone marrow findings as well as other clinical variables of interest in South African patients with HIV-associated thrombocytopenia. METHODS Seventy-eight HIV-positive patients with thrombocytopenia were enrolled from the Charlotte Maxeke Johannesburg Academic Hospital. The IPF levels were measured using a Sysmex XE-5000 haematology analyzer and were correlated with bone marrow and other findings. RESULTS The median IPF was 7.6%, ranging from 1.3 to 44%. It was raised in 78% of patients with immune thrombocytopenia (ITP) (median = 16.3%) and low in 79% of patients with hypocellular marrow (median = 6.5%). Surprisingly, it was highly variable among patients with malignant marrow infiltration and mycobacterial infection of the bone marrow (BMTB) (median = 8.4 and 7.1%, respectively). Multivariate linear regression analysis confirmed a significant independent inverse relationship between the IPF and hypocellular marrow (P < 0.0001), a marginally significant positive association with ITP (P = 0.059), and the absence of any relationship with malignant infiltration or BMTB. The IPF had a significant inverse association with the platelet count (P = 0.0006), but was unrelated to the CD4 count and exposure to anti-retroviral therapy. Unexpectedly, it showed a significant positive association with the HIV viral load (P = 0.005). We speculate this to reflect increased megakaryocyte activity in compensation for accelerated platelet clearance due to HIV-driven platelet activation. CONCLUSION This study investigates the role of the IPF in HIV-associated thrombocytopenia, and emphasizes the limitations of morphological analysis in determining megakaryocyte function.
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Moussa MM, Mowafy N. Preoperative use of romiplostim in thrombocytopenic patients with chronic hepatitis C and liver cirrhosis. J Gastroenterol Hepatol 2013; 28:335-41. [PMID: 22849409 DOI: 10.1111/j.1440-1746.2012.07246.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Patients infected with hepatitis C virus (HCV) often develop chronic liver disease, liver cirrhosis and concurrent thrombocytopenia, which manifests as decreased platelet counts and bleeding complications. Romiplostim, a thrombopoietin mimetic peptibody that stimulates the thrombopoietin receptor, has been used as a treatment for primary immune thrombocytopenia. We monitored the efficacy of preoperative romiplostim over 90 days in 35 male patients with chronic hepatitis C, liver cirrhosis and thrombocytopenia secondary to HCV infection. METHODS Romiplostim was administered at 2 μg/kg Q1W for a maximum of one month with a target platelet count of 70 × 10(9)/L as a prerequisite for planned surgeries. Bone marrow aspirate was collected at baseline and at the end of the study, along with liver and kidney function assessments. A complete blood count was performed every third day throughout the study period. RESULTS A rapid response to romiplostim therapy was observed, with 33/35 patients achieving platelet counts ≥ 70 × 10(9)/L and thereby eligible for surgery. An initial mean platelet count of 31 × 10(9)/L increased to a maximum peak range of 73-240 × 10(9)/L, occurring between days 18 and 39. The reticulin bone marrow grade remained negative in all patients. Surgical interventions were associated with no postoperative bleeding or thrombotic complications. CONCLUSIONS Preoperative romiplostim administration may represent a viable alternative to increase platelet counts to a level acceptable for elective surgical interventions in patients with chronic liver disease and severe thrombocytopenia secondary to HCV infection who are unresponsive to standard therapy. Further studies in larger numbers of patients and over a longer period of time are warranted.
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Affiliation(s)
- Mohamed M Moussa
- Internal Medicine and Hematology Department, Ain Shams University, Cairo, Egypt.
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Abstract
OBJECTIVES To investigate the mechanisms of platelet kinetics in the Strategies for Management of Antiretroviral Therapy (SMART) study that demonstrated excess mortality with CD4 guided episodic antiretroviral therapy (ART) drug conservation compared with continuous treatment viral suppression. Follow-up analyses of stored plasma samples demonstrated increased activation of both inflammatory and coagulation pathways after stopping ART. DESIGN SMART patients from sites that determined platelets routinely. METHODS Platelet counts were retrospectively collected from 2206 patients from visits at study entry, and during follow-up. D-dimer levels were measured at study entry, month 1, and 2. RESULTS Platelet levels decreased in the drug conservation group following randomization, but remained stable in the viral suppression group [median (IQR) decline from study entry to month 4: -24 000/μl (-54 000 to 4000) vs. 3000 (-22 000 to 24 000), respectively, P < 0.0001)] and the rate of developing thrombocytopenia (<100 000/μl) was significantly higher in the drug conservation vs. the viral suppression arm (unadjusted drug conservation/viral suppression [HR (95%CI) = 1.8 (1.2-2.7)]. The decline in platelet count among drug conservation participants on fully suppressive ART correlated with the rise in D-dimer from study entry to either month 1 or 2 (r = -0.41; P = 0.02). Among drug conservation participants who resumed ART 74% recovered to their study entry platelet levels. CONCLUSION Interrupting ART increases the risk of thrombocytopenia, but reinitiation of ART typically reverses it. Factors contributing to declines in platelets after interrupting ART may include activation of coagulation pathways or HIV-1 replication itself. The contribution of platelets in HIV-related procoagulant activity requires further study.
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Gentile I, Bonadies G, Buonomo AR, Minei G, Borrelli F, Foggia M, Chiurazzi F, Borgia G. Resolution of autoimmune thrombocytopenia associated with raltegravir use in an HIV-positive patient. Platelets 2012; 24:574-7. [PMID: 23130846 DOI: 10.3109/09537104.2012.735721] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
About 10% of the human immunodeficiency virus (HIV) patients show thrombocytopenia. We describe the case of an HIV/HCV-positive patient whose autoimmune thrombocytopenia resolved with the addition of raltegravir to previous highly active antiretroviral therapy (HAART). It is noteworthy that the effect on platelet count appeared to be independent of viral load suppression, which was achieved with previous antiretroviral regimens. In fact, it has been suggested that the positive effect exerted by raltegravir on autoimmune diseases is due to its inhibition on herpes viruses, and hence on activation of endogenous human retroviruses. This consideration, if confirmed, could open new avenues in the treatment of autoimmune thrombocytopenia in the HIV setting.
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Affiliation(s)
- Ivan Gentile
- Dipartimento di Medicina Pubblica e Sicurezza Sociale, Sezione di Malattie Infettive, Università di Napoli "Federico II" , Naples , Italy
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Immunological HCV-associated thrombocytopenia: short review. Clin Dev Immunol 2012; 2012:378653. [PMID: 22829850 PMCID: PMC3400398 DOI: 10.1155/2012/378653] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 06/07/2012] [Accepted: 06/14/2012] [Indexed: 02/08/2023]
Abstract
Infection with Hepatitis C virus (HCV) is affecting about 3% of the world's population, leading to liver damage, end-stage liver disease, and development of hepatocellular carcinoma, being thus the first indication for liver transplantation in the USA. Apart from the cirrhotic-liver-derived clinical signs and symptoms several conditions with immunological origin can also arise, such as, glomerulonephritis, pulmonary fibrosis, and thrombocytopenia. HCV-related autoimmune thrombocytopenia shows specific pathogenetic characteristics as well as symptoms and signs that differ in severity and frequency from symptoms in patients that are not HCV infected. Aim of this short paper is to estimate the epidemiological characteristics of the disease, to investigate the pathogenesis and clinical manifestation, and to propose treatment strategies according to the pertinent literature.
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Clinical Features, Treatment, and Outcome of HIV-Associated Immune Thrombocytopenia in the HAART Era. Adv Hematol 2012; 2012:910954. [PMID: 22693513 PMCID: PMC3368161 DOI: 10.1155/2012/910954] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/11/2012] [Accepted: 03/01/2012] [Indexed: 01/08/2023] Open
Abstract
The characteristics of HIV-associated ITP were documented prior to the HAART era, and the optimal treatment beyond HAART is unknown. We performed a review of patients with HIV-associated ITP and at least one platelet count <20 × 109/L since January 1996. Of 5290 patients in the BC Centre for Excellence in HIV/AIDS database, 31 (0.6%) had an ITP diagnosis and platelet count <20 × 109/L. Initial ITP treatment included IVIG, n = 12; steroids, n = 10; anti-RhD, n = 8; HAART, n = 3. Sixteen patients achieved response and nine patients achieved complete response according to the International Working Group criteria. Median time to response was 14 days. Platelet response was not significantly associated with treatment received, but complete response was lower in patients with a history of injection drug use. Complications of ITP treatment occurred in two patients and there were four unrelated deaths. At a median followup of 48 months, 22 patients (71%) required secondary ITP treatment. This is to our knowledge the largest series of severe HIV-associated ITP reported in the HAART era. Although most patients achieved a safe platelet count with primary ITP treatment, nearly all required retreatment for ITP recurrence. New approaches to the treatment of severe ITP in this population are needed.
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Varma S, Kumar S, Garg A, Malhotra P, Das A, Sharma A, Chawla YK, Dhiman RK. Hepatitis C virus infection among patients with chronic immune thrombocytopenic purpura in northern India. J Clin Exp Hepatol 2011; 1:68-72. [PMID: 25755317 PMCID: PMC3940252 DOI: 10.1016/s0973-6883(11)60124-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 09/17/2011] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Subhash Varma
- Departments of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India
| | - Shiv Kumar
- Departments of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India
| | - Ashish Garg
- Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India
| | - Pankaj Malhotra
- Departments of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India
| | - Ashim Das
- Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India
| | - Arpita Sharma
- Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India
| | - Yogesh K Chawla
- Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India
| | - Radha K Dhiman
- Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India
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Reviewed diagnosis of primary and secondary immune thrombocytopenic purpura in 79 adult patients hospitalized in 2000-2002. Blood Coagul Fibrinolysis 2011; 22:1-6. [PMID: 20962625 DOI: 10.1097/mbc.0b013e3283401286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the accepted distinction between primary and secondary immune thrombocytopenic purpura (ITP), a systematic analysis of the incidence of secondary ITP is not available. The present study was aimed at verifying the frequency and, consequently, the approximate rates of prevalence and incidence of secondary ITP and analysing its clinical and laboratory characteristics in patients needing ordinary hospital treatment for ITP. The study was based on 79 consecutive, adult ITP patients admitted to three Italian hospitals in 2000-2002. Using data collected in a previous study on the appropriateness of hospital management of ITP, we evaluated the frequency of secondary ITP, with the diagnosis formulated on the basis of new acquisitions, derived its rates of prevalence and incidence, and examined the available clinical and laboratory parameters. At our case review, a diagnosis of secondary ITP could be formulated in 38% of the 79 patients. This frequency was significantly higher than that determined at the time the patients were discharged from hospital (13.9%) (P = 0.000). The derived rates of prevalence and incidence of secondary ITP in the general population were, respectively, 2.3 and 1.23 per 100 000 inhabitants per year. In comparison with patients with primary ITP, those with a secondary form more frequently had spleen enlargement (P = 0.000), hepatomegaly (P = 0.001) and lower haemoglobin values (P = 0.005). The high frequency of secondary ITP must be mainly attributed to the currently available knowledge about the nature of some forms of ITP. Particular contributors to the high frequency were cases secondary to infections and those observed in patients who had undergone bone marrow or solid organ transplantation. Some clinical and laboratory alterations appear to be more frequent in secondary ITP than in primary ITP. However, the importance that the identification of particular forms of ITP, such as those secondary to Helicobacter pylori or hepatitis C virus infections, has on the choice of treatment suggests that these conditions must be ascertained independently of the presence or absence of clinical and laboratory alterations.
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Vannappagari V, Nkhoma ET, Atashili J, Laurent SS, Zhao H. Prevalence, severity, and duration of thrombocytopenia among HIV patients in the era of highly active antiretroviral therapy. Platelets 2011; 22:611-8. [PMID: 21612330 DOI: 10.3109/09537104.2011.582526] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Thrombocytopenia is a clinically relevant outcome in HIV. However, the epidemiology of this condition, including frequency, severity, and duration, has not been well-characterized in the era of highly active antiretroviral therapy (HAART). In this study, we describe the epidemiology of thrombocytopenia using two methods. We conducted a systematic review of the literature published between 1997 and 2009 to characterize the frequency of thrombocytopenia in different populations in the HAART era. Secondly, we examined the frequency, severity, and duration of thrombocytopenia among HIV patients in the Collaborations in HIV Outcomes Research/US (CHORUS) Cohort from 1997 to 2006 and among HIV patients participating in GlaxoSmithKline HIV Clinical Trials between 1996 and 2004. Prevalence estimates of thrombocytopenia (<150 000 platelets/µl) in the literature varied greatly but were generally above 10%. The thrombocytopenia prevalence estimates in the CHORUS Cohort and the HIV Clinical Trials were both 14%. In the CHORUS Cohort, the platelet count was ≤50 000/µl among 3.1% and ≤30 000/µl among 1.7%; in the HIV clinical trials database, the platelet count was ≤50 000/µl among 1.3% and ≤30 000/µl among 0.67%. Duration of severe thrombocytopenia varied greatly, with the medium duration to ≥75 000 platelets/µl taking 147 days in the CHORUS Cohort and 33 days in the HIV clinical trials database. Among 111 patients with severe thrombocytopenia in the CHORUS Cohort, 23% never achieved a higher platelet count over follow-up. In conclusion, while the prevalence of severe thrombocytopenia was low, it occurred at levels associated with bleeding and was persistent among a small proportion of patients despite receipt of HAART.
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Abdollahi A, Morteza A. Serum concentrations of antiphospholipid and anticardiolipin antibodies are higher in HIV-infected women. Rheumatol Int 2011; 32:1927-32. [DOI: 10.1007/s00296-011-1859-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
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Ayesh Haj Yousef MH, Alawneh KM. Candida albicans-induced chronic thrombocytopenic purpura. Acta Haematol 2011; 126:202-4. [PMID: 21860227 DOI: 10.1159/000329901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 06/06/2011] [Indexed: 12/27/2022]
Abstract
We present 2 patients with chronic immune thrombocytopenic purpura (ITP) secondary to Candida albicans infection. Neither patient responded to standard ITP therapy including splenectomy. Appropriate antifungal treatment of the C. albicans infection was followed by sustained improvement in platelet count in both patients. To our knowledge, this is the first report of ITP in association with C. albicans infection.
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Affiliation(s)
- Mahmoud H Ayesh Haj Yousef
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
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Factor VIII concentration is greater in female than male patients with HIV infection. Int J Hematol 2010; 93:53-8. [PMID: 21161619 DOI: 10.1007/s12185-010-0736-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 11/15/2010] [Accepted: 11/22/2010] [Indexed: 01/07/2023]
Abstract
The purpose of the present study was comparing plasma markers of coagulation between men and women in both HIV-infected patients and controls. Fifty-eight HIV-infected patients and 58 healthy participants who were individually matched with patients in age and sex were included in the study. We simultaneously collected blood samples for CD4+ T cell count, CD8+ T cell count, platelets count, hemoglobin, partial thromboplastin time (PTT), prothrombin time, international normalized ratio and blood type measurements. We used fresh plasma of the studied population to measure factor VIII, fibrinogen, antithrombin, protein C and protein S levels. CD4+ T cell count, CD8+ T cell count, platelet count, PTT, plasma fibrinogen, antithrombin, protein C and protein S levels were significantly lower, and plasma factor VIII levels were significantly higher in HIV patients. Factor VIII levels were significantly higher in HIV-infected women than HIV-infected men [200 (181-258) vs. 170 (150-194), p < 0.05]. This difference remained significant [219.7 (195.8-248.7) vs. 158 (136.5-180.3), p < 0.001] after multiple adjustments for age, CD8+ and CD4+ T cell count, using general linear model. Plasma factor VIII concentration was significantly higher in HIV-infected women after stratifying the patients into O, B, A and AB blood groups when there was not any gender difference in controls. We suggest that there is a sexual dimorphism in factor VIII concentration in HIV-infected patients.
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Affiliation(s)
- P Philippe
- Service de médecine interne, centre de compétences cytopénies auto-immunes, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
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