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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 62-63

Immune thrombocytopenia is different from thrombotic thrombocytopenic purpura


Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, 1120 15thSt., Augusta, GA 30912, USA

Date of Submission17-Oct-2019
Date of Acceptance18-Oct-2019
Date of Web Publication11-Mar-2020

Correspondence Address:
Dr. Mafdy N Basta
Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, 1120 15th St., Augusta, GA 30912
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacc.JOACC_46_19

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How to cite this article:
Basta MN. Immune thrombocytopenia is different from thrombotic thrombocytopenic purpura. J Obstet Anaesth Crit Care 2020;10:62-3

How to cite this URL:
Basta MN. Immune thrombocytopenia is different from thrombotic thrombocytopenic purpura. J Obstet Anaesth Crit Care [serial online] 2020 [cited 2020 Apr 1];10:62-3. Available from: http://www.joacc.com/text.asp?2020/10/1/62/280364



Dear Sir,

I would like to take the opportunity to address the correspondence to JOACC regarding the manuscript titled thrombotic thrombocytopenic purpura during pregnancy.

First, I would like to start by clarifying the major differences between immune thromobocytopenia (ITP), referred at letter to editor, and thrombotic thrombocytopenic purpura (TTP), presented at the manuscript.

Immune thrombocytopenia (ITP), also called idiopathic thrombocytopenic purpura, or immune thrombocytopenic purpura, is an acquired thrombocytopenia caused by autoantibodies against platelet antigens.

ITP can be primary due to autoantibody-mediated platelet destruction or secondary to an underlying condition including, among others, HIV infection, hepatitis C virus (HCV) infection, systemic lupus erythematosus, and chronic lymphocytic leukemia.

Some cases of ITP can be preceded by viral infection. Antibodies against viral antigens may cross-react with normal platelet antigens (a form of molecular mimicry). Infection with HIV, HCV, cytomegalovirus, and varicella-zoster virus have been proposed to cause secondary ITP by this mechanism.

Less commonly, preceding bacterial infections may be implicated. Bacterial products, such as lipopolysaccharide, may attach to platelet surfaces and can increase platelet phagocytosis. Helicobacter pylori infection may contribute to the development of ITP in some cases by an unknown mechanism that might include molecular mimicry, immune alterations, and activities of bacterial products such as cytotoxin-associated gene A (CagA).[1]

Observational studies have suggested that therapy for H. pylori infection may improve platelet counts in some individuals with moderate to severe ITP who are from endemic geographical regions such as Japan and Italy.[2],[3]

On the other hand, TTP, an example of thrombotic microangiopathy, unlike ITP, is associated with microangiopathic hemolytic anemia, as inferred by the presence of schistocytes on the peripheral blood smear, along with thrombocytopenia, and signs of organ injury.[4] It can be acquired TTP due to an inhibitor (autoantibody) directed against ADAMTS13 or hereditary secondary to inherited ADAMTS13 mutations. Diffuse microvascular thrombosis cause thrombocytopenia from platelet consumption in thrombi. Contrary to individuals with ITP, who are otherwise well, patients with TTP are often quite ill. Literature review did not reveal a correlation between TTP and Helicobacter pylori infection.

Concerning preeclampsia, a meta-analysis of observational studies that examined the relationship between maternal infection and preeclampsia reported that the risk of preeclampsia was increased in pregnant women with urinary tract infection and periodontal disease. There were no associations between preeclampsia and presence of antibodies to Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus; treated and nontreated HIV infection; malaria; herpes simplex virus type 2; bacterial vaginosis; or Mycoplasma hominis.[5]

Low-dose aspirin is the only drug for which there is convincing evidence of benefit in reducing the risk of preeclampsia.[6] In populations with low calcium intake, elemental calcium supplementation for pregnant women can reduce the risk of preeclampsia.[7] Preconception weight loss can reduce the risk of developing preeclampsia.[8]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Stasi R, Provan D. Helicobacter pylori and Chronic ITP. Hematology Am Soc Hematol Educ Program 2008:206-11. doi: 10.1182/asheducation-2008.1.206.  Back to cited text no. 1
    
2.
Stasi R, Sarpatwari A, Segal JB, Osborn J, Evangelista ML, Cooper N, et al. Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: A systematic review. Blood 2009;113:1231-40.  Back to cited text no. 2
    
3.
Rostami N, Keshtkar-Jahromi M, Rahnavardi M, Keshtkar-Jahromi M, Esfahani FS. Effect of eradication of Helicobacter pylori on platelet recovery in patients with chronic idiopathic thrombocytopenic purpura: A controlled trial. Am J Hematol 2008;83:376-81.  Back to cited text no. 3
    
4.
Page EE, Kremer Hovinga JA, Terrell DR, Vesely SK, George JN. Thrombotic thrombocytopenic purpura: Diagnostic criteria, clinical features, and long-term outcomes from 1995 through 2015. Blood Adv 2017;1:590-600.  Back to cited text no. 4
    
5.
Conde-Agudelo A, Villar J, Lindheimer M. Maternal infection and risk of preeclampsia: Systematic review and metaanalysis. Am J Obstet Gynecol 2008;198:7-22.  Back to cited text no. 5
    
6.
Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: Systematic review and meta-analysis. Am J Obstet Gynecol 2017;216:110-20.  Back to cited text no. 6
    
7.
Hofmeyr GJ, Betrán AP, Singata-Madliki M, Cormick G, Munjanja SP, Fawcus S, et al. Prepregnancy and early pregnancy calcium supplementation among women at high risk of pre-eclampsia: A multicentre, double-blind, randomised, placebo-controlled trial. Lancet 2019;393:330-9.  Back to cited text no. 7
    
8.
Mostello D, Jen Chang J, Allen J, Luehr L, Shyken J, Leet T. Recurrent preeclampsia: The effect of weight change between pregnancies. Obstet Gynecol 2010;116:667-72.  Back to cited text no. 8
    




 

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