title: Anti-Hepatitis C Virus Serology in Immune Thrombocytopenia: A Retrospective Analysis in 101 Patients.
abstract: Hepatitis C virus (HCV), an RNA virus, is known to be the major cause of post-transfusion non-A, non-B hepatitis. HCV can induce several expressions of autoimmunity, including both serological abnormalities and clinical disorders. The relationship between the HCV infection and anti-platelet autoimmunity has been occasionally described, but is still far from well-defined. We retrospectively analysed 101 serum specimens, collected between 1988 and 1994, from patients with immune thrombocytopenia (ITP) for the presence of anti-HCV antibodies. Eighty-seven patients were classified as having idiopathic, and 14 secondary ITP (4 systemic lupus erythematosus, 9 non-Hodgkin's lymphoma and 1 Evan's syndrome). Anti-HCV antibodies were determined by second generation tests (ELISA + RIBA). A specimen was considered positive for HCV antibodies in the presence of ELISA reactivity (sample optical density/cut-off > 1.00) accompanied by RIBA reactivity to at least one HCV specific antigen. 20 sera (20%) were positive, with a prevalence higher in secondary than in idiopathic ITP (43% vs. 16%, p < 0.05). No differences were found between anti-HCV positive and negative patients regarding gender, platelet count, platelet associated immunoglobulins, hepatitis B virus serology and liver enzyme profile. On the contrary, mean age was higher in the HCV positive vs HCV negative ones (58±18SD vs. 44±20yrs, p < 0.01), in keeping with the increasing prevalence of HCV infection with ageing. HCV positive patients, showed a poor response to treatment (platelet count lower than 50,000/μl after conventional medical therapy for immune thrombocytopenia) compared to anti-HCV negative ones, (50% versus 7.3%, p < 0.001). When we excluded patients who were exposed to risk factors for HCV infection after ITP diagnosis and before the serum collection, the prevalence of anti-HCV antibodies was not very different (17.6%) from that found in the series as a whole (19.8%). Our results seem to indicate that HCV infection may play a role in triggering several cases ITP, and moreover might constitute a negative prognostic factor for therapy response.
authors.affiliation: a Institute of Medical Semeiotics, University of Padua Medical School.
authors.forename: F
authors.initials: F
authors.lastname: Fabris
authors.affiliation: a Institute of Medical Semeiotics, University of Padua Medical School.
authors.forename: F
authors.initials: F
authors.lastname: Salvan
authors.affiliation: a Institute of Medical Semeiotics, University of Padua Medical School.
authors.forename: R
authors.initials: R
authors.lastname: Silla
authors.affiliation: b Blood Transfusion Service , Padua City Hospital , Padua , Italy.
authors.forename: A R
authors.initials: AR
authors.lastname: Lazzaro
authors.affiliation: a Institute of Medical Semeiotics, University of Padua Medical School.
authors.forename: I
authors.initials: I
authors.lastname: Cordiano
authors.affiliation: a Institute of Medical Semeiotics, University of Padua Medical School.
authors.forename: A
authors.initials: A
authors.lastname: Girolami A
authors.affiliation: b Blood Transfusion Service , Padua City Hospital , Padua , Italy.
authors.forename: P
authors.initials: P
authors.lastname: Marson
keywords: Hepatitis C; immune thrombocytopenia