The Clinical Analysis Of Idiopathic Thrombocytopenic Purpura In Patients With Chronic Hepatitis C Virus Infection

Idiopathic thrombocytopenic purpura(ITP) is characterised byincreased platelet destruction without definite etiopathogenisis.That result in platelet phagocytosis by the reticuloendothelialsystem (RES).Several reports,have shown a high prevalence ofhepatitis C virus (HCV)infection in patients with ITP.Furthermo-re,Hepatitis C virus infection has often been suggested as apossible cause of various kinds of autoimmune diseases.Objective:The aim of this study was to determine the relati-onship between idiopathic thrombocytopenic purpura (ITP)and hep-atitis C virus infection and to characterize the clinical featu-res of anti-HCV antibody (HCVab) positive ITP patients.Method:We reviewed the medical records for all patients ev-aluated for ITP between January 2000 and June 2005.522 patientswere diagnosised as ITP.342 patients were screened for HCV infe-ction at the time of initial diagnosis.Of 342 patients who fulf-illed criteria for ITP,36 of(10.5%) 342 patients were HCVab ser-opositive.24 of 36 patients were HCV-RNA positive.The HCVab ser-opositive group comprised 20 females and 4 males (age range,28-69).The HCVab seronegative group comprised 22 patients(females 18,males 4 ,age range,18-65yr).Result:Of 342 patients who fulfilled criteria for ITP,36 of(10.5%) 342 patients were HCVab seropositive.HCVab-positive wereolder [mean age (±SD) 49.05±11.4 years vs. 35.95±13.1years,p<0.05] and equally distributed between both sexes.Symptoms andsigns of thrombocytopenia were less frequent in HCVab-positive.HCVab-positive patients had less severe thrombocytopenia.No dif-ference between two group in immunoglobulin,alexine,PAIgG andantinuclear antibodyes.Two group show a normal or increased num-ber of bone marrow megakaryocytes;absence of myelodysplasticfeatures on bone marrow.But HCV-ab positive ITP was hyperplasiacompared with ITP.Treatment of patients with HCV-ab ITP is animportant and unresolved problem particularly because the mecha-nism responsible for the occurrence of thrombocytopenia in theseindividuals remains unclear.The various treatment used,includingsteroids, intravenousimmunoglobulin (IVIg) and spleenctomy.Asfor our study.All the patients treated with steroids immunoglob-ulimopathy and(or) immunoglobulin ,splenectyomy.Nobody treatedwith IFN.There is significant difference between two groups.Tre-atment with steroids proved effective in increasing plateletcounts in both the HCV-Seropositive and seronegative patients.But the total response rate to various treatment was signifycantlyhigher HCV-ab negative than HCV-ab positive,(p<0.05).Infection withHCV appears to be a frequent cause of thrombocytopenia.Therefore,wewould recommend screening all patients presenting with ITP for thepresence of HCV,as a different treatment strategy should be employedin these patients.In patients diagnosed with HCV-ab positive ITPwithout clinically evident liver disease,treatment with INFcombination therapy should be considered.Improvements in plateletcount should parallel a reciprocalsupp-ression of viral load anderadication of HCV infection should r-esult in complete remission ofthe thrombocytopenia.Conclusion :The infection rate of HCV was 10.5% in ITP diagnos-ised by our hospital.HCV-ab positive patients were older and eq-ually distributed between both sexes.Symptoms and signs of thro-mbocytopenia were less frequent in HCV-ab positive patients.HCV-ab positive ITP patients had less severe thrombocytopenia. Nodifference between two group in Immunoglobulin,alexine ,PAIgG andantinuclear antibodyes.HCV-ab positive ITP was hyperplasia comp-ared with HCV-ab negative in bone marrow megakaryocytes.The tot-al response rate to various treatment was significantly higherHCV-ab negative ITP than HCV-ab positive ITP.