New Aspects in Pathogenesis of Primary Immune Thrombocytopenia In Pediatric Patients

Document Type : Original Article

Authors

1 Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.

2 Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni-Suef,Egypt.

3 Clinical pathology department, Faculty of Medicine, Beni-Suef University, Egypt.

Abstract

Background: Immune thrombocytopenia is an autoimmune condition marked by a reduced number of platelets in the blood, which can be caused by either a breakdown of platelets inside the blood vessels or the abnormal synthesis of platelets in the bone marrow. although autoantibodies have been shown as the principal factor in the pathogenesis of immune thrombocytopenia, also cellular immune modulation has been recognized to have a vital role in the pathophysiology of ITP. Aim of the Work: the pathogenesis of primary immune thrombocytopenia in pediatric patients. Patients and Methods: A Case-Control, analytical research that has been performed over one year after the approval of the research ethics committee on 70 participants (twenty-four) men & (forty-six) females with ages varying from (2 years) to (13 years) & an average age of (6.28±2.86) years old, Cases underwent history taking & clinical investigation. Laboratory investigations included CBC, DPC, ESR, bleeding time, C- C-reactive protein, and single nucleotide polymorphism. Conclusion: consanguinity was associated with ITP.  It is widely recognized that the pathogenesis of immune thrombocytopenia is significantly influenced by environmental & genetic factors. The susceptibility of cases to immune thrombocytopenia is influenced by single-nucleotide polymorphisms (SNP) of inflammatory cytokine loci, including IL-10, IL-17F, TNF-β, TNF-α, IL-6, TGF-β1, INF-γ, & IL0-1A. Additionally, various autoimmune disorders are related to genetic variants of inflammation-related genes, involving  CD226, CD24,IL-2, FCRL3,  ITGAM, IRF5,CARD8, NLRP3,  SH2B3, PTPN22, TNFAIP3, TRAF1, & STAT4.           

Keywords

Main Subjects

References

  1. Lambert MP, Gernsheimer TB.(2017) . Clinical updates in adult immune thrombocytopenia. Blood 129:2829–35. doi: 10.1182/blood-2017-03-754119.
  2. Morodomi Y , Kanaji S , Won E , Ruggeri ZM , Kanaji T .(2020). Mechanisms of anti-GPlba antibody-induced thrombocytopenia, Blood; 135 (25): 2292-2301.
  3. Audia, S., Mahévas, M., Samson, M., Godeau, B., & Bonnotte, B. (2017). Pathogenesis of immune thrombocytopenia. Autoimmunity reviews, 16(6), 620-632.
  4. Chen L, Flies DB.(2013) . Molecular mechanisms of T cell co-stimulation and inhibition. Nat Rev Immunol 13:227–42. doi: 10.1038/nri3484 .
  5. Lim EL, Okkenhaug K.(2019) . Phosphoinositide 3-kinase delta is a regulatory T-cell target in cancer immunotherapy. Immunology (2019) 157:210–8. doi: 10.1111/ imm.13082 .
  6. Vernerova L, Spoutil F, Vlcek M, Krskova K, Penesova A, Meskova M, et al.(2016) . ACombination of CD28 (rs1980422) and IRF5 (rs10488631) Polymorphisms Is Associated with Seropositivity in Rheumatoid Arthritis: A Case-Control Study. PloS One (2016) 11:e0153316. doi: 10.1371/journal.pone. 0153316.
  7. Wang, M. J., Yang, H. Y., Zhang, H., Zhou, X., Liu, R. P., & Mi, Y. Y. (2016). TNFAIP3 gene rs10499194 and rs13207033 polymorphisms decrease the risk of rheumatoid Oncotarget, 7(50), 82933.
  8. Terrell, D. R., Beebe, L. A., Vesely, S. K., Neas, B. R., Segal, J. B., & George, J. N. (2010). The incidence of immune thrombocytopenic purpura in children and adults: a critical review of published reports. American journal of hematology, 85(3), 174-180
  9. Rui, L., Schmitz, R., Ceribelli, M., & Staudt, L. M. (2011). Malignant pirates of the immune system. Nature Immunology, 12(10), 933-940.
  10. Huang, J., Yang, Y., Liang, Z., Kang, M., Kuang, Y., & Li, F. (2015). Association between the CD24 Ala57Val polymorphism and risk for multiple sclerosis and systemic lupus erythematosus: a meta-analysis. Scientific reports, 5(1), 9557.
  11. Abdaljabbar, H. N., Faraj, S. A., & AL-Rubae, A. M. (2020). Study of Immune Thrombocytopenia (ITP) in Iraqi children in Wasit Province. EurAsian Journal of BioSciences, 14(2).
  12. Taha, G. E. M., Ahmed, A. B., & Mabrouk, A. G. (2022). Chemokine 12 plasma level in pediatric patients with Immune Thrombocytopenic purpura and its relation to Disease Activity. Egyptian Journal of Medical Research, 3(2), 213-225.
  13. Diab, A. M., Abouamer, A. A., Motaleb, G. S. A., Eid, K. A., & Abdelnaiem, H. I. (2021). Prognostic evaluation of immune thrombocytopenia outcomes in Egyptian children: a retrospective single-center experience. Вопросы гематологии/онкологии и иммунопатологии в педиатрии, 20(3), 26-30.
  14. Ali, A., Zahad, S., Masoumeh, A., & Azar, A. (2008). Congenital malformations among live births at Arvand Hospital, Ahwaz, Iran-A prospective study. Pakistan Journal of Medical Sciences, 24(1), 33.
  15. Ariawati, K., & Setiyawan, I. M. K. (2019). Platelets level response after three days therapy in children with acute Immune Thrombocytopenic Purpura (ITP): a 10 years’ experience at the tertiary hospital. Bali Medical Journal, 8(3), 897-901.
  16. Mohammed, M. A., Ahmed, A. S., Zidan, A. A., & Abd EL-Hakam, A. M. (2022). Study of Clinical Features and Laboratory Findings in Children with Immune Thrombocytopenia. The Egyptian Journal of Hospital Medicine, 87(1), 2096-2100.
  17. AL-Zuhairy, S. H. (2013). Evaluation of prognostic factors in newly diagnosed childhood primary immune thrombocytopenia (ITP): a two-year prospective study at Al-Sadder Hospital, Missan Province. Med J Babylon, 10, 855-69.
  18. Ismail, A. M., Higazi, A. M., Nomeir, H. M., & Farag, N. M. (2021). IL-23/Th17 pathway and IL-17A gene polymorphism in Egyptian children with immune thrombocytopenic Italian Journal of Pediatrics, 47, 1-8.
  19. Mohammed, M. A., Ahmed, A. S., Zidan, A. A., & Abd EL-Hakam, A. M. (2022). Study of Clinical Features and Laboratory Findings in Children with Immune Thrombocytopenia. The Egyptian Journal of Hospital Medicine, 87(1), 2096-2100.
  20. El-hady, M. A., Mosallam, D. S., Anis, S. K., Mansour, B. S., & Yassa, M. E. (2021). Tumor necrosis factor-induced protein 3 gene polymorphism and the susceptibility to chronic primary immune thrombocytopenia in Egyptian children: a case-control study. Egyptian Journal of Medical Human Genetics, 22(1), 1-9.
  21. Fida, N. M., Hamed, E., Jaber, S., Al Najjar, S., Al Amawi, D., Al Siny, F., & Alharthy, B. (2021). Presentation and Management of Primary Immune Thrombocytopenia in Children at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia: A Retrospective Study. Journal of King Abdulaziz University-Medical Sciences, 28(1), 1-9.
  22. El-hady, M. A., Mosallam, D. S., Anis, S. K., Mansour, B. S., & Yassa, M. E. (2021). Tumor necrosis factor-induced protein 3 gene polymorphism and the susceptibility to chronic primary immune thrombocytopenia in Egyptian children: a case-control study. Egyptian Journal of Medical Human Genetics, 22(1), 1-9.
  23. Ismail, A. M., Higazi, A. M., Nomeir, H. M., & Farag, N. M. (2021). IL-23/Th17 pathway and IL-17A gene polymorphism in Egyptian children with immune thrombocytopenic purpura. Italian Journal of Pediatrics, 47, 1-8.
  24. Zitek, T., Weber, L., Pinzon, D., & Warren, N. (2022). Assessment and management of immune thrombocytopenia (ITP) in the emergency department: current perspectives. Open Access Emergency Medicine, 25-34.
  25. Terrell, D. R., Neunert, C. E., Cooper, N., Heitink-Pollé, K. M., Kruse, C., Imbach, P., ... & Ghanima, W. (2020). Immune thrombocytopenia (ITP): current limitations in patient management. Medicina, 56(12), 667.
Egyptian Journal of Medical Research
Volume 5, Issue 4
October 2024
Pages 221-235

Files

Share

How to cite

Statistics