Cytokines and immunoglobulin derangement in egyptian children with primary immune thrombocytopenic purpura

Background Immune thrombocytopenic purpura (ITP) is a heterogeneous immune-mediated disorder in which the immune system reacts with cytokine-mediated T lymphocytes and a platelet autoantigen(s). Aim The aim of this study was to detect helper T-1 and T-2 response through assessment of tumor necrosis factor (TNF)-α and interleukin (IL)-6, respectively, and immunoglobulin (Ig)M, IgG, and IgA in patients with acute and chronic ITP and to detect their possible roles as predictors of the course of the disease. Patients and methods This cross-sectional case-control study, conducted at Ain Shams University, recruited 20 patients with ITP (10 acute and 10 chronic) and 10 age-matched and sex-matched healthy controls. All were subjected to detailed clinical assessment, assessment of serum IL-6 and TNF-α using enzyme-linked immunosorbent assay, and serum IgA, IgM, and IgG using nephlometric method. Results Mean serum values of IgM and IgG were statistically lower in patients with acute ITP, and statistically higher serum values of TNF-α were detected in patients with acute and chronic ITP compared with controls. IL-6 levels were statistically higher in acute ITP when compared with chronic ITP and with controls and a higher significant value in chronic ITP than controls. There were significant positive correlations between IgM, IgG, and platelet count and a significant negative correlation between both TNF-α and IL-6 and platelet count. On follow-up of patients with acute ITP, one of them developed a chronic progressive course, and this patient was found to have low serum levels of IgA and IgG at presentation. Conclusion Children with primary ITP had dysfunction at cytokine and serum Ig level.