الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
 |  | from | 151 |  |  |
| | | from | 151 | | |
Abstract
Background: Immune thrombocytopenic purpura (ITP) is an autoimmune disorder in which the immune system reacts with cytokine mediated T-lymphocytes and a platelet auto-antigen(s) resulting in thrombocytopenia due to immune-mediated platelet destruction and/or suppression of platelet production.
Aim of work: This study was designed to assess serum levels of IL-6, TNFα- and immunoglobulin G, M and A in patients with acute and chronic ITP; to detect their correlations to each other and to other hematological parameters; and examine their possible roles as predictors of the course of the disease.
Subject and method: This case-control study was conducted at Hematology/Oncology Department, Ain Shams University, Egypt. Patients were classified according to disease duration into acute ITP (<3 months) (n=10), and chronic ITP (>1 year) (n=10). Ten age- and sex-matched healthy children were also enrolled in this study. They were all subjected to detailed clinical assessment. Serum IL6 and TNFα were assessed using ELISA, and serum Ig A, M and G were detected using nephlometric method (MININEPH).
Results: Mean serum levels of IgM and IgG were decreased in ITP patients with significant positive correlations to platelet count. IgG values were found to be decreased in 70% of acute ITP patients showing statistically significant relation when compared to controls (P< 0.05). The mean levels of serum TNF-α and IL-6 were increased in ITP patients with significant negative correlations to platelet count. They were both increased in all acute ITP patients. In chronic ITP, 70% and 80% of patients showed increased levels of serum TNF-α and IL-6 respectively showing a high statistical significant relation compared to controls (P< 0.001). There was a significant negative correlation between serum levels of IgG and Il-6 among patients. On following up of acute ITP patients, one of them developed a chronic progressive course, this patient was found to have low serum levels of IgA and IgG at presentation.
Conclusion: Low serum levels of IgA and IgG at presentation might predict chronic progression of the disease. Again, Increase in serum cytokines levels (IL-6 and TNF-α) in ITP patients supports the theory that the imbalance in serum cytokine levels of helper t-cells plays a role in the pathophysiology of the disease This hypothesis should be challenged by further prospective studies on larger number of patients with primary ITP for longer periods of follow up to reach the possible mechanisms by which abnormalities in Igs and cytokines may influence the disease course, response to treatment and the severity of bleeding.