ABSTRACT
Thrombopoietin [TPO], the primary regulator of platelet production, is produced in liver, kidney, spleen and bone marrow stroma. However, little is known about the development of thrombocytopenia in hepatitis C infection. The aim of the present study was to investigate TPO levels, and its haematological role - if any - in patients with hepatitis C infection. Forty patients with chronic hepatitis C infection [20 thromboeytopenic and 20 non thrombocytopenic] and 20 healthy controls were studied. Serum TPO was measured by a monoclonal antibody based sandwich enzymelinked immunosorbent assay for all subjects. In addition, liver function tests, HCV-Abs, PCR for HCV RNA, platelet count, platelet aggregation and complete blood picture were performed for all patients. Decreased serum level of TPO was evident in HCV infected patients with thrombocytopenia and in HCV infected patients without thrombocytopenia when compared to control subjects. Platelet aggregation were low in HCV infected patients with thrombocytopenia and in HCV infected patients without thrombocytopenia in comparison to normal controls. Significant direct correlation was found between TPO and platelet count in both patients' groups. Also, significant direct correlation was found between TPO levels and platelet aggregation in all studied groups. There were significant correlation between TPO and prothrombin time in both groups of patients. Statistically significant decreased serum TPO in HCV infected patients can be attributed to decreased production from the liver in patients with chronic HCV infection. In this work, significant direct correlation was found between TPO and the studied blood indices, haemoglobin, R.B.Cs, W.B.Cs and prothrombin time for groups of patients. These data support the hypothesis that TPO have an erythropoietic activity. In conclusion, TPO levels were low in HCV infected patients. The therapeutic role of TPO insight of these findings still remains to be more elaborated. It can play a role in ameliorating thrombocytopenia in patients with liver cirrhosis
ABSTRACT
Most patients with chronic renal failure [CRF] undergoing renal replacement therapy require life-long treatment with recombinant human erythropoietin [r-HUEPO] to stimulate erythropoietin and reverse anemia at least partially. The aim of the present study was to evaluate erythropoiesis in patients with CRF and the role of soluble transferring receptor as a Ferro kinetic measure of iron status in those patients. Twenty CRF patients under regular haemodialysis [HD], twenty CRF patients under regular HD and under treatment with r-HUEPO and twenty healthy controls were studied. Serum soluble transferring receptors [STFR] were measured by ELISA immunoassay method as an estimate of erythropoietin activity using two different monoclonal antibodies specific for STFR. In addition, R.B. Cs count, Hb level, R.B. Cs indices, ferrokinetic studies [serum iron, serum ferritin, total iron binding capacity [TIBC], transferrin saturation], adequacy of dialysis [KT/ V], kidney function tests, Na+ and K+. The study showed a significant increase in STFR in CRF patients in comparison to control, but it was significantly higher in CRF haemodialyzed patients non receiving r-HUEPO. Evidence of functional iron deficiency was found in 100% of our patients by estimation of STFR and normal or even high serum iron and serum ferritin levels. Improvement of iron mobilization and metabolism in haemodialyzed patients under treatment With r-HUEPO was evidenced by the significant difference in STFR on comparing non-treated to treated group and also evidenced by significant higher levels of haemoglobin and RBCS count in treated group compared to non-treated one
In conclusion: Functional iron deficiency is a major cause of anaemia among patients with CRF on regular HD. Treatment of anaemia in CRF patients is achieved mainly by r-HUEPO and with Intravenous iron to avoid resistance to erythropoictin. The main cause of anaemia in CRF patients Was erythropoietin deficiency. The determination of STFR reflects erythropoietin activity and may be Considered as a sensitive tool for early prediction of iron deficiency among patients with CRF and also for follow tip of iron status during treatment with erythropoietin