الفهرس 
IMMUNE THROMBOCYTOPENIAOnly 14 pages are availabe for public view
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Abstract
Free oxygen radicals may have an effect on the structural and functional behavior of platelets and might play a role in pathogenesis of thrombocytopenia in chronic ITP. Aim: To assess oxidant -antioxidant systems initially in patients with (ND) and chronic (ITP) and evaluate effect of antioxidant therapy on, platelet count, bleeding score (BS) and oxidant status during 6 months follow-up. Methods: An interventional 6 months prospective randomized open-labeled study; in patients aged 1-18 years with chronic ITP. Patients were randomly allocated to one of two groups. Group 1(interventional arm) included 24 chronic ITP patients, all received antioxidant therapy (1 tablet contains: Vit. A 2000 IU, Vit C 90 mg, Vit E 15 mg and selenium 55 ug ),while Group 2 (non-interventional arm), included 12 chronic ITP patients, did not receive the antioxidant therapy. Both groups were comparable and matched with healthy controls (n= 30).The primary efficacy endpoints were the difference between both groups in the change from baseline to 6 months in BS using Bolton-Maggs bleeding score, mean platelet count, total antioxidant capacity (TAC), catalase (CAT), reduced glutathione (GSH) (markers of antioxidant status) and serum malondialdehyde (MDA) levels. The safety endpoint was the occurrence of serious or life threatening bleeding, complete response to therapy, and adverse events related to therapy. Results: Baseline platelet count and markers of antioxidant status were significantly lower in chronic ITP patients than those in healthy controls (P<0.001). In addition, in this group, baseline MDA, was significantly higher than ealthy controls (P<0.001).In chronic ITP patients, end of study levels of TAC, CAT, GSH (p<0.001), mean platelet count(p=0.027) were statistically higher in patients receiving antioxidant whereas MDA was statistically lower (P<0.001). A negative correlation between platelet count and MDA levels in ITP patients(r: 0.491, P=0.004). Conclusion: High oxidative stress,observed in chronic ITP, may be an association playing role in its pathophysiology. Scavenging of oxygen free radicals ameliorated the oxidative stress, thrombocytopenia and bleeding in ITP patients.
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mmune thrombocytopenia (ITP) is an immune-mediated hematologic disorder with increased platelet destruction and decreased platelet production leading to thrombocytopenia and, thus, mucocutaneous bleeding. Oxidative stress occurs as a result of increased activity of free radical–producing enzymes, decreased activity of free radical–removing enzymes, and insufficient levels of antioxidants. Free oxygen radicals may have an effect on the structural and functional damage of platelets and plays a role in pathogenesis of thrombocytopenia in both, acute and chronic ITP.
Thus the aim of the study was to assess oxidant and antioxidant systems initially in patients with chronic immune thrombocytopenia (ITP) and to evaluate effect of antioxidant therapy on, platelet count and antioxidant status during 6 months follow-up.
The study was an interventional 6 months prospective randomized open-labeled study conducted at Hematology Clinic, Children Hospital Ain Shams University in patients aged less than 18 years with chronic ITP. Patients were randomly allocated to one of two groups. Those in group 1(interventional arm) included twenty-four patients with chronic ITP and all received antioxidant therapy (1 tablet (Antox®) (Mepaco). contains: Vit. A 2000 IU, Vit C 90 mg, Vit E 15 mg and selenium yeast 55 ug), while those in Group 2, (non-interventional arm), included twelve patients with chronic ITP, did not receive the antioxidant therapy. Both groups were comparable and compared with age and sex matched healthy controls. The primary efficacy endpoints were the difference between both groups in the change from baseline to 6 months in mean platelet count, bleeding score, total antioxidant capacity (TAC), catalase (CAT), reduced glutathione (reduced-GSH) and serum malondialdehyde (MDA)levels. Total antioxidant capacity (TAC), catalase (CAT), reduced glutathione (reduced-GSH) and serum malondialdehyde (MDA) levels were measured baseline and 6 months later at end of study. The end of study samples were assessed when patients were 2 weeks off antioxidant therapy. In addition, patients had complete blood count every month, and monthly detailed clinical examination with assessment of bleeding score.
Results from this study showed a significantly higher level of MDA, markers of oxidative stress, as well as lower levels of TAC,GSH and CAT in patients with chronic ITP compared to healthy controls(p<0.01), indicating a higher oxidative stress in ITP patients in comparison to healthy control group.
This study evaluated the possible beneficial effect of adjuvant antioxidant therapy on chronic ITP patients. Group1 patients receiving antioxidant therapy showed significant reduction in MDA, with mean values 20.58±9.24 compared to 10.36±8.1 after antioxidant therapy (p<0.01). In addition, TAC, GSH and CAT were found to show significant increase in response to antioxidant therapy (p<0.01). These findings suggest that the free-radical scavenging effect of antioxidant ameliorates the oxidative stress.
Additionally in chronic ITP patients receiving antioxidant therapy, mean platelet count significantly improved compared to the other group (p=0.027).