T-cell Imbalance or Decreased Th:Tc Ratio in Immune Thrombocytopenia: Is it Clinically Significant?

Aisha Arshad, Samina Naz Mukry, Munira Borhany, Tahir Shamsi


Background: Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by low platelet count and various contributing factor. The imbalance in T cells may also cause ITP. Therefore, the present study was planned to assess the role of  T-cells in pathogenesis of ITP and also to evaluate any possible link of Th:Tc imbalance to disease severity.

Methods: The present study was conducted  with 111 patients of ITP and similar number of controls as case control study with 1:1 ratio of from January 2017 to July 2019. The patients were grouped according to the guideline of ASH as  newly diagnosed/persistent ITP(ND-ITP/P-ITP) and chronic/refractory ITP(C-ITP/R-ITP).The blood samples were obtained, and CBC parameters were observed using advanced hematology analyzer XN-1000.The T cells subset analysis was evaluated by BD FACS Calibur flow cytometer. The Fisher exact test was done to evaluated the difference among the groups with (p=<0.05) by using SPSS version 19.

Results: Significantly reduced levels of hemoglobin, platelet counts with elevated IPF were observed in ND-ITP/P-ITP and C-ITP/R-ITP patients (p=<0.001).The significantly low Th:Tc ratio (p=<0.001) predicts imbalance of T cells in ND-ITP/P-ITP (0.86±0.47) as compared to control group (1.73±0.46).The mean of 0.84±0.34 Th:Tc ratio was observed in C-ITP/R-ITP children with ≤16 years. An insignificant difference (p= 0.89) was linked between children with non-severe chronic (0.84±0.42), severe chronic (0.82±0.49) and refractory ITP (0.85±0.51).

Conclusion: In ITP patients’ low levels of Th:Tc ratio was observed suggesting dysregulation of immune system. The chronicity of the disease may be linked to elevated production of Tc in children (≤16 years) with C-ITP/R-ITP.

Keywords: Immune thrombocytopenia; Platelets counts; Helper T-cells (Th); Cytotoxic T-cells (Tc)  

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