الفهرس 
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Abstract
Viral hepatitis results in around 1.4 million deaths each year, HBV and HCV are responsible for about 90% of these fatalities. Although viral hepatitis is a major public health problem across the globe it has not been prioritised until now. Lately, the“2030 Agenda for Sustainable Development Goals” of WHO has identified specific actions to prevent viral hepatitis.
Chronic hepatitis infection produces hepatic and extra-hepatic issues, including thrombocytopenia, which might impair invasive surgeries like staging biopsies. chronic hepatitis infection-induced liver fibrosis and cirrhosis produce portal hypertension, hypersplenism, immunological reactivity with anti-platelet antibodies, platelet sequestration, bone marrow suppression with diminished thrombopoeitin synthesis, and endothelial dysfunction, all of which can lead to thrombocytopenia.
CD55 and CD59 may directly interfere with normal complement function. CD59 is a GPI-anchored protein that binds to host cells and platelets. CD59 can bind to complement C8 or C9 and block the development of the complement membrane attack complex.
CD55, a complement activation regulator, is well-known for speeding up the decay of C3 convertase on the surface of the host cell in order to minimize excessive complement activation. CD55 is expressed on the plasma membrane of all blood cells and almost all other cell types in immediate contact with plasma component proteins. both classical and alternative activation pathways are inhibited by CD55.
Therefore, the aim of the present study was to assess expression of complement regulatory proteins (CD59 and CD55) on the platelet surface in patients with hepatitis associated thrombocytopenia.
The study was a case- control study was carried out in the laboratory of the Clinical and Chemical Pathology Department of Sohag University Hospital in period from July 2020 to March, 2022. 90 subjects were selected and then classified into three main groups:
group I: Hepatitis B virus patients with thrombocytopenia.
group II: Hepatitis C virus patients with thrombocytopenia.
group III: Immune Thrombocytopenia patients as a control group.
All patients were subjected to full history taking, clinical examination, laboratory investigations (CD55, CD59, CD61 and CD42 Flow cytometry complete blood count, liver function tests, HCV, HBS).
Summary of our results
● There was a significant difference in red blood cells count (RBCs), hemoglobin level (HB) and platelets (PLT)) between the three groups (P =0.012, 0.024, 0.016).
● Significant difference in red blood cells count (RBCs), hemoglobin level (HB) and platelets (PLT)) between group II & III (=0.009, 0.025, 0.033) respectively and significant difference between group I & III in platelets (PLT) (=0.032)
● There was significant difference in the absolute values of CD55, CD59, CD 61 and CD42 between the three groups (P= 0.001, 0.014, 0.021 and <0.001).
● significant when group I compared to group III control subjects (0.001, 0.022, 0.046 and <0.001) and significant when group II compared with group III control subjects 0.028, 0.039, 0.038 and 0.013).
● There was significant difference between Gender of patients and CD59 ratio level (P = 0.033).
● Absolute counts of CD55+ platelets showed statistically significant positive correlation with CD59 (P <0.001).
● Absolute counts of CD61+ platelets showed a statistically significant positive correlation with CD42.
● Absolute counts of CD42+ platelets showed a statistically significant positive correlation with RDW (p = 0.002).
Conclusion
In patients with hepatitis, there was significant reduction in CD55 and CD59 compared to the control group. While there was significant increase in CD42 and CD61 compared to the control group Moreover, strong positive correlation between CD55 and CD59 was recorded. Suggesting that CD55 and CD59 could be a predictor for late-stage hepatitis accompanied by thrombocytopenia monitoring that is important for practitioners in determining the diagnosis and choice of treatment for patients.
Recommendations
● Further prospective studies are needed in order to validate these findings.
● CD55 and CD59 could be a valuable marker for prediction of hepatitis at late stages.
● Multi-centric prospective studies are needed to further determine the immune thrombocytopenia in hepatitis patients.
Limitations
● It was a single centric study.
● The relatively small sample size.
● No healthy control group was enrolled in the study.
● This work lacked the studying of the complementary proteins’ concentration in different stages of infection.