الفهرس 
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Abstract
Background: Thrombocytopenia is a frequent haematological defect that complicates the course of a variety of clinical conditions. Understanding the potential pathogenetic mechanims of thrombocytopenia is necessary for proper management of thrombocytpenia patients. TPO is the major hormone controlling platelet production which is primarily produced by the liver. Measurement of serum TPO has been recently emerged as a new laboratory test for evaluation of patients with thrombocytopenia Aim of work: The present study was designed to assess the value of the thrombopoietin assay in thrombocytopenic patients in order to determine which conditions that of benefit from its use in replacement therapy. Methods: To achieve this aim, we measured serum TPO levels in 63 patients; 40 cases with liver diseases including (11 cases with hepatitis C viral infection, 10 cases with liver cirrhosis and 19 cases with hepatosplenic schistosomiasis), 10 cases with acute myeloid leukemia before and after induction of chemotherapy, 6 cases with chronic ITP and 7 cases with acute ITP, in addition to 14 healthy subjects with matched age and sex as control. Results: There was significant difference between TPO levels in all studied groups. There was significant increase of TPO levels in patients with HCV and cirrhosis compared to control group. There was significant decrease of TPO levels in patients with liver cirrhosis compared to HCV group. There was non significant increase of TPO levels in bilharzial group compared to control group. There was significant increase of TPO levels in patients with AML before as well as after chemotherapy compared to control. There was non significant increase of TPO levels in patients with chronic ITP compared to control. There was non significant decrease of TPO levels in patients with acute ITP compared to pediatric control. There was significant positive correlation between TPO levels and BM cellularity in all studied groups. There was significant negative correlation between TPO levels and each of splenic size and BM cellularity in liver disease group. There was significant positive correlation between TPO levels and TLC in the group of liver cirrhosis. There was significant positive correlation between TPO levels and MPV in acute ITP group. At platelet count of (60x 109/L) as a cut off value. The level of TPO was significantly lowered in patients with platelet count< 60 x 109/L compared to those with platelet count 60 x 109/L. ROC analysis showed that, at TPO level of 368.75 pg/ml, we could classify the liver disease groups into aetiologic subgroups. The sensitivity of TPO was 73.7% with specificity of 60.9% and with over all accuracy of 70.7%. Conclusion: Thrombocytopenia in liver cirrhosis, AML and ITP appears to be not related to plasma TPO levels, other factors might be acting e.g. c-mpL antibodies, TPO antibodies or platelet associated antibodies. Recommendations: Other implicated factors as a potential causes of thrombocytpenia e.g. antibodies to TPO, TPO receptor (c-mpL) and platelets associated antibodies are to be implemented to characterize the potential mechanisms of liver disease-associated thrombocytopenia.