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Blood, 1 February 2004, Vol. 103, No. 3, pp. 890-896.
Prepublished online as a Blood First Edition Paper on August 14, 2003; DOI 10.1182/blood-2003-03-0900.
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HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
Does Helicobater pylori initiate or perpetuate immune thrombocytopenic purpura?
Marc Michel,
Nichola Cooper,
Christelle Jean,
Christine Frissora, and
James B. Bussel
From the Department of Pediatrics, Division of Hematology/Oncology, and Department of Medicine, Division of Gastroenterology, Weill Medical College of Cornell University, New YorkPresbyterian Hospital, New York, NY.
To determine the prevalence of Helicobacter pylori (H pylori) infection in North American patients with immune thrombocytopenic purpura (ITP) and the effect of H pylori eradication on the platelet count, a prospective study was performed. Seventy-four patients aged 10 years and older (mean age of 41 years) with chronic ITP and a platelet count below 60 x 109/L were enrolled. H pylori infection was found in 22% of patients by means of a breath test and could not be predicted by gastrointestinal symptoms. H pyloripositive patients (52.5 years of age) were older than H pylorinegative patients (38.5 years of age; P = .0035). Fifteen of the 16 H pyloripositive patients were treated and the bacteria was eradicated in 14 (93%). After 3 months, a significant response (platelet count > 50 x 109/L and doubling the initial count) was observed in only one patient. After a median follow-up of 11.5 months, none of the 14 patients had responded. Ten H pylorinegative patients treated with the same regimen also did not increase their platelet counts. In conclusion, unlike several previous reports, this study does not implicate H pylori in the pathogenesis of ITP since the prevalence of H pylori infection was low and eradication of H pylori did not positively influence the course of the ITP.

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