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Autoimmune Thrombocytopenic Purpura and Helicobacter pylori Infection
Marc Michel, MD;
Mehdi Khellaf, MD;
Lionel Desforges, MD;
Ketty Lee, MD;
Annette Schaeffer, MD;
Bertrand Godeau, MD;
Philippe Bierling, MD, PhD
Arch Intern Med. 2002;162:1033-1036.
Background The mechanisms triggering the production of platelet autoantibodies
in autoimmune thrombocytopenic purpura (AITP) are poorly understood. Recently,
marked improvements in platelet counts have been reported in patients with
AITP and concurrent Helicobacter pylori infection
after eradication of H pylori by a standard antibiotic
regimen. We looked for an association between H pylori
infection and AITP in adults.
Methods Fifty-one adults of white French origin, negative for human immunodeficiency
virus (mean ± SD age, 40 ± 19.8 years), with AITP and a platelet
count of less than 50 x 103/µL at onset were included.
Thirty-five consecutive nonthrombocytopenic patients (mean ± SD age,
43 ± 22 years) of the same origin and with unknown H pylori status served as control subjects. Antibodies against H pylori were detected by means of an agglutination method
in both patients and control subjects. Sex ratio, mean age, hemorrhagic manifestations,
response to corticosteroid therapy, and final outcome were compared in H pylori–negative and H pylori–positive patients with AITP. To test for a possible molecular
mimicry mechanism, we also used an immunoblot assay to look for specific H pylori antibodies in platelet eluates from 3 H pylori–positive patients with AITP.
Results Seroprevalence of H pylori in patients with
AITP (15 [29%]) was not significatively different from that in control subjects
(10 [29%]). The H pylori–positive and H pylori–negative patients with AITP did not differ
in main characteristics at AITP onset, response rate to corticosteroids, and
final outcome. None of the 3 patients investigated had H pylori antibodies in platelet eluates.
Conclusion Although the role of H pylori in a subgroup
of patients with AITP cannot be excluded, we found no evidence of an association
between H pylori infection and AITP.
From the Service de Médecine Interne (Drs Michel, Khellaf, Schaeffer,
and Godeau), Laboratoire de Bactériologie (Dr Desforges), and Laboratoire
d'Immunologie Leuco-plaquettaire, Etablissement Français du Sang (Drs
Lee and Bierling), Hôpital Henri-Mondor, Créteil, France.
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