Association of Helicobacter pylori Infection with Clinical Characteristics and Steroid Response in Patients with Immune Thrombocytopenia: An Observational Study

Authors

  • Murtadha Salah Shyaa Department of Clinical Pharmacy, College of Pharmacy, Mustansiriyah University, Baghdad, Iraq
  • Manal Khalid Abdulridha Department of Clinical Pharmacy, College of Pharmacy, Mustansiriyah University, Baghdad, Iraq
  • Abdulhakim Mohammad Abdullah Department of Clinical Pharmacy, College of Pharmacy, Hodeidah University,Al Hudaydah, Yemen
  • Yaseen Mohyaldeen Taher National Center of Hematology, College of Medicine, Mustansiriyah University, Baghdad, Iraq

DOI:

https://doi.org/10.32947/ajps.v26i1.1388

Keywords:

Immune thrombocytopenia, Helicobacter pylori, Corticosteroid response, ABO blood group, Autoimmune thrombocytopenia, Platelet count

Abstract

Background: Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by reduced platelet counts. Helicobacter pylori infection has been implicated in ITP pathogenesis, though its effect on clinical features and initial treatment response remains unclear.

Objective: To assess the impact of H. pylori infection on baseline characteristics, platelet counts, and corticosteroid response in adult ITP patients, including the role of ABO blood groups.

Methods: This observational comparative study included 100 adult primary ITP patients, equally divided into H. pylori-positive and negative groups based on stool antigen testing. Clinical and laboratory data were analyzed, and steroid response was evaluated using standard criteria. Statistical tests and logistic regression were applied to identify predictors of outcomes.

Results: Baseline characteristics and platelet counts were comparable between groups. Steroid response rates were similar (56% vs 54%, P=0.84). Among blood group Of patients, H. pylori-positive individuals had significantly lower platelet counts than negatives (P<0.001). In positive group, male sex predicted better steroid response, while higher BMI correlated with refractory disease. No independent predictors were identified in the negative group.

Conclusion: H. pylori infection does not affect baseline platelet levels or initial steroid response in ITP. However, interactions with host factors, particularly ABO blood group and sex, may influence disease severity and treatment outcomes.

References

1- Kohli R, Chaturvedi S. Epidemiology and clinical manifestations of immune thrombocytopenia. Hämostaseologie. 2019;39(03):238–249.

2- Andrès E, Mecili M, Fothergill H, Zimmer J, Vogel T, Maloisel F. Gender-related analysis of the clinical presentation, treatment response and outcome in patients with immune thrombocytopenia. Presse Med. 2012;41(9 Pt 1):e426–431.

3- Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood, The Journal of the American Society of Hematology. 2009;113(11):2386–2393.

4- Zufferey A, Kapur R, Semple JW. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia (ITP). Journal of clinical medicine. 2017;6(2):16.

5- Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood advances. 2019;3(23):3829–3866.

6- Klein SL, Flanagan KL. Sex differences in immune responses. Nature Reviews Immunology. 2016;16(10):626–638.

7- Stasi R, Sarpatwari A, Segal JB, et al. Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review. Blood. 2009;113(6):1231–1240.

8- Franchini M, Veneri D. Helicobacter pylori-associated immune thrombocytopenia. Platelets. 2006;17(2):71–77.

9- Takahashi T, Yujiri T, Shinohara K, et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol. 2004;124(1):91–96.

10- Nejabat M, Motamedifar M, Amiri Zadeh Fard S. Effects of ABO Blood Groups and Helicobacter pylori on COVID-19 Susceptibility and Disease Severity: Findings from a Cross-Sectional Analysis. Iranian Journal of Colorectal Research. 2025;13(1).

11- Dentali F, Sironi AP, Ageno W, et al. Relationship between ABO blood group and hemorrhage: a systematic literature review and meta-analysis. Paper presented at: Seminars in thrombosis and hemostasis2013.

12- Franchini M, Capra F, Targher G, Montagnana M, Lippi G. Relationship between ABO blood group and von Willebrand factor levels: from biology to clinical implications. Thrombosis journal. 2007;5(1):14.

13- Veneri D, Bonani A, Franchini M, Fedrizzi A, Pizzolo G. Idiopathic thrombocytopenia and Helicobacter pylori infection: platelet count increase and early eradication therapy. Blood Transfusion. 2011;9(3):340.

14- Hattab M, Milhem F, Jallad H, et al. Helicobacter pylori Eradication for Immune Thrombocytopenia Reduces Non-response and Raises Platelet Counts: Meta-analysis of Randomized Trials.

15- Dogan A E, ES. Effect of Helicobacter pylori infection on the first-line treatment outcomes in patients with immune thrombocytopenic purpura. European Review for Medical and Pharmacological Sciences (Eur Rev Med Pharmacol Sci). 2021;26:3995–4000.

16- Sayan O, Erikci AA, Ozturk A. The Efficacy of Helicobacter pylori Eradication in the Treatment of Idiopathic Thrombocytopenic Purpura–The First Study in Turkey. Acta haematologica. 2006;116(2).

17- Ghadaki B, Nazi I, Kelton JG, Arnold DM. Sustained remissions of immune thrombocytopenia associated with the use of thrombopoietin receptor agonists. Transfusion. 2013;53(11):2807–2812.

18- Vianelli N, Auteri G, Buccisano F, et al. Refractory primary immune thrombocytopenia (ITP): current clinical challenges and therapeutic perspectives. Ann Hematol. 2022;101(5):963–978.

19- McCombe P. Gender differences in Autoimmune Disease 6. 2014.

20- Payandeh M, Raeisi D, Sohrabi N, et al. Poor platelet Count Response to Helicobacter Pylori Eradication in Patients with Severe Idiopathic Thrombocytopenic Purpura. Int J Hematol Oncol Stem Cell Res. 2013;7(3):9–14.

21- Sultan S, Irfan SM, Kaker J, Hasan M. Efficacy of helicobacter pylori eradication as an upfront treatment of secondary immune thrombocytopenia: an experience from Pakistan. Med J Malaysia. 2016;71(2):53–56.

22- Moulis G, Germain J, Rueter M, et al. Eltrombopag in adult patients with immune thrombocytopenia in the real-world in France, including off-label use before 6 months of disease duration: The multicenter, prospective ELEXTRA study. Am J Hematol. 2022;97(2):E40–e44.

23- Tran H, Dix C, Bird R, et al. Efficacy and Long-Term Outcomes of Eltrombopag Treatment Within 6 Months of Diagnosis in Patients With Steroid Unresponsive or Dependent Immune Thrombocytopenia. American Journal of Hematology. 2025;100(3):516–519.

24- Satoh K, Hirayama T, Takano K, et al. VacA, the vacuolating cytotoxin of Helicobacter pylori, binds to multimerin 1 on human platelets. Thromb J. 2013;11(1):23.

25- Provan D, Arnold DM, Bussel JB, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood advances. 2019;3(22):3780–3817.

26- Mizutani H, Furubayashi T, Imai Y, et al. Mechanisms of corticosteroid action in immune thrombocytopenic purpura (ITP): experimental studies using ITP-prone mice,(NZW x BXSB) F1. 1992.

27- Ghanima W, Cooper N, Rodeghiero F, Godeau B, Bussel JB. Thrombopoietin receptor agonists: ten years later. Haematologica. 2019;104(6):1112.

28- Furman D, Campisi J, Verdin E, et al. Chronic inflammation in the etiology of disease across the life span. Nature medicine. 2019;25(12):1822–1832.

29- Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. The Journal of clinical investigation. 2017;127(1):1–4.

Downloads

Published

2026-03-31

How to Cite

Association of Helicobacter pylori Infection with Clinical Characteristics and Steroid Response in Patients with Immune Thrombocytopenia: An Observational Study. (2026). Al Mustansiriyah Journal of Pharmaceutical Sciences, 26(1), 115-131. https://doi.org/10.32947/ajps.v26i1.1388

Similar Articles

1-10 of 299

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)