Title: Working Group on Thrombocytopenias
1Working Group on Thrombocytopenias
European Hematology Association
2AITP in HCV positive patients
- A study cohort proposal for a muticentric survey
3Abd El Hamid, A. S. MD
- Professor of Clinical Pathology
- Faculty of Medicine
- Suez Canal University Ismailia, Egypt
- alaasaad_at_superlink.com.eg
4Viral infection associated with thrombocytopenia
- 1- Hepatitis viruses (A, B, C)
- 2- HIV (Human immune deficiency virus)
- 3- Varicella-zoster virus
- 4- Epstein-Barr virus
5HCV infection
- HCV hepatotropic Virus
- 1- Hepatic complications
- Chronic hepatitis
- Liver cirrhosis
- Hepatic cell failure
- Hepatocellular carcinoma
6EXTRAHEPATIC MANIFESTATIONS IN HCV INIFECTION
- HCV infection of other types of cells like
HSC, etc. will be accompanied with dysfunction
of different organs by direct and indirect
pathomechanisms.
7EXTRAHEPATIC MANIFESTATIONS IN HCV INIFECTION
Cont.
- Endocrine Hashimoto's disease, Diabetes
mellitus, - Muscles and joints Rheumatoid arthritis
- Dermatological Lichen planus, Urticaria
- Ophthalmic Uveitis, corneal ulcers
- Salivary gland Sialadenitis
- Kidney Glomerutonephritis
- Miscellaneous Polyarteritis nodosa
8Hematological and lymphoid complications of HCV
infection
- Thrombocytopenias
- Mixed cryoglobulinemia and vasculitis
- Aplastic anemia
- Non-Hodgkin's B lymphomas
9Causes of TP in CLD
- 1- Hypersplenism sequestration of platelets in
the enlarged spleen. - 2- Immunological dysregulation triggering the
production of platelet autoantibodies - 3- Hypothrombopoietinemia in advanced liver
disease. - 4- HCV direct infection of platelets and
megakaryocytes - 5- Myelosuppression due to HCV direct infection
of the hematopoietic stem cells
10AITP in HCV positive patients
11Materials and methods
- Place of study Suez canal university hospital
situated in Ismailia city in the eastern part of
Egypt serving 5 governorates with a population
size of 3 million - Study population 212 HCV positive patients
attending the hepatology unit in SCU hospital
12Inclusion criteria
- 12 patients had fulfilled the following criteria
of HCV associated AITP - Diagnosis of HCV positive anti-HCV detectable
HCV viraemia. - Diagnosis of (AITP) Low platelet count, i.e. lt
50x109/L.
13- Normal or increased number of bone marrow
megakaryocytes. - Absence of myelodysplastic features on bone
marrow. - Absence of drug intake or coagulopathy.
- Absence of other causes of thrombocytopenia.
14Patients characteristics
15Hemorrhagic Manifestations
16Autoimmune Markers
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18HCV associated AITP
- A Proposal for a muticentric survey
19- An increasing interest is being focused on HCV
associated AITP not only because the high
prevalence of HCV infection worldwide the high
frequency Anti-HCV reported in AITP patients,
- but also because it represents an obstacle that
could hamper invasive diagnostic or therapeutic
procedures.
20Hypothesis
- Clinically, the differentiation of AITP from
other forms of TP can influence diagnostic
therapeutic measures. - Studies that emphasized the association of HCV
infection with AITP had involved either
hospital-based populations or had small sample
sizes
21- or carried out retrospectively in AITP
patients groups only. Therefore, for better
definition and characterization of HCV associated
AITP it is suggested - to study AITP in HCV infected patients in HCV
hyperendemic areas which will be complimentary
for such studies carried out in AITP patients
groups.
22Aims of the study
- The objectives of this international
multi-centric study are as follow - 1- Primary Objective
- Frequency characterization (Clinico-pathological
, hematological and virologic and response to
treatment) of AITP in HCV positive patients
23- Secondary Objectives
- To study the natural history of AITP associated
with HCV infection based on a long-term follow-up
study to define - The clinical course
- The cost-effectiveness of testing
treatment options.
24- Characterization of the platelet auto-antibodies
associated with AITP in HCV infection as regards
the following - The platelet glycoprotein specificity,
autoantibody titer in relation to therapy.
25Research Questions
1- What is the frequency of TP and AITP in HCV
infection without significant liver damage? 2-
What are the various pathomechanisms that may
result in TP in HCV infection? 3- What are the
clinical lab parameters pertaining to a
possible association of AITP in HCV and may
assist in the diagnosis?
26The study design
- 1-Phase-I Cross sectional study prevalence of
AITP in HCV infected patients. - 2- Phase-II Prospective study HCV positive
patient without AITP will be follow for one year
to discover the AITP new cases - 3-Phase III Analytical study characterization
of the platelet Abs associated with AITP in HVC
infection regarding the specificity of the
platelet glycoprotein target in HCV-AITP .
27- The final version of the proposal will be
available online at the site www.tcpeha.org
28Thrombocytopenia Hot issue!!!!
Is it cold???!!!