الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Idiopathic throlllhocytopcnic purpura (1’1’1’) is a couuuon
haernorrhagic syndrome characterized hy reduced number or
circulating platelets. normal 10 iru.rcased number of
megakaryocytes and accelerated platelet destruction .
To establish the autoimmune nature of this disorder and to •
find out the pathogenetic significance of serum anticardiolipin
antibodies in this disease ,fifty patients suffering from ITP
(twenty- five with acute ITP and twenty - five with chronic ITP)
and also, age- and sex - matched twenty healthy children serving
as controls had beenOsubjccted to the following:
I. Detailed history taking:
Onset. course. duration and history of bleeding. vaccination or
fever.
2. Full medical examination:
Skin lcxion», hypcrpyrexlu, orgunomeguly (lymph nodes. liver
and spleen) .
3. I.ahoralory work:
a) Routine investigations:
Bleeding lime, haemogram with total leucocytic and differential
counts.
h) Haematological investigations :
Platelet count, bone marrow aspirate and Coombs’ Test ( direct
and j ndircct ) .
c) Immunological investigations:
I. Estimation of serum IgG, IgA, IgM,C3 and C4 using
SUMMARY AND CONCLUSION 126
Radial immune diffusion.
2. Demonstration of anti-CMV antibodies of the IgG and IgM
types using ELISA technique . ~.
o
1. nt’led ion of circulaling immune complexes using HUSI\
technique • l4’
t~ ~
!
4. Dcte<.:lion of antinuclear, anti-ds-DNA, non-organ specific
and anti-thyroid antibodies by indirect immunofluor•escence
technique.
,_-t
,
5. Detection of serum antiplatelet antibodies by
immunofluorescence technique.
6. Detection of Anticardiolipin antibodies of the IgG and IgM
types using EUSA technique.
Statistical analysis of the results showed;
Al] cases studied had prolonged bleeding tiruc.Cljuiculty ;
fever, spontaneous purpura and bleeding were statistil.:ally
more prevalent in acute group as compared to both chronic and
control groups.
The haemoglobin level was significantly lower in both
patient groups as compared to the controls . also • it was
significantly lower in acute ITP patient group as compared to
chronic ITP patient group.The mean total leueocytic count and
absolute eosinophilic count were significantly higher in both
patient groups as compared to’ the control group, also. they
were significantly higher in acute rTP group as compared to
chronic ITP group.
o
SUMMARY AND CONCLUSION 127
The mean ’platelet count was significantly lower in both
p.uicru groups as compared 10 control group • also . it was
significantly lower in acute TTPgroup as compared to chronic
ITt> 1’.1”011 P .
Serum IgG and IgM levels were significantly higher in
both patient groups as compared to control group, but there
was no significant change in serum IgG or IgM in acute ITP
group as compared to chronic ITP group.
There was insignificant change in serum IgA . C3 or C4
levels in patient groups as compared to control groups.
The anti-CMV IgG results were significantly higher in
both patient groups as compared to controls, also. anti-CMV
IgM results were significantly higher in both patient groups as
compared to control group.
The results of non-organ specific autoantibodies showed
insignificant difference in both patient groups us compared to
each other.
Anticardiolipin - IgG level was significantly higher in both
patient groups as compared to control group . While .
anticardiolipin IgM and circulating immune complex levels
were insignificantly different in both patient groups as
compared to control group.
As many as ,·76% of acute ITP patients and 80% of
chronic ITP patients were positive for antiplatelet antibodies.
The correlations found in the results were between the
platelet count and haemoglobulin concentration, absolute
SUMMARY AND CONCLUSION 128
eosinophilic count ,serum IgM, serumlgA, serum CJ and
serum (’4 levels.
Hcncc , we could cOlll’llIdl’ lhal;
ITP in Egyptian’ children may be an autoimmune disease
accompanied by the presence of serum antiplatelet antihodies ,
<Inticardiolipin antibodies, circulating immune complex and
even non-organ speci ric autoantibodies.
A palpable spleen strongly negates the diagnosis of
chronic ITP in children.
The rising specific anti-CMV 19G titer is more useful in
screening for active CMV infection than the specific anti-
CMV TgM titer.