The Oxidative Stress and Antioxidant Status at Children with Immune Thrombocytopenic Purpura

Immune thrombocytopenic purpura (ITP), which is an autoimmune, selflimiting and benign course, characterized by an increase in the destruction of thrombocytes in circulation, is the most common cause of acquired childhood thrombocytopenia. Clinically, it has two major forms, as acute and chronic. Highdose methylprednisolone (MP) and intravenous immunoglobulin (IVIG) are preferred as the preliminary treatment of childhood ITP. This preference is based upon costs and side effects, as success rates of the treatments do not vary. Oxidative stress plays a role in the pathogenesis of autoimmune diseases. Oxidative stress and free radicals can be responsible for pathogenesis and prognosis of ITP. This study examined level of oxidative stress and the effects of various treatment choices on antioxidant capacity in acute and chronic ITP. The study consisted of 44 cases diagnosed as ITP. The cases were divided into two groups (Group I: Acute ITP [n:33] and Group II: Chronic ITP [n:11]). The acute ITP group was then divided into subgroups as Group Ia (MP [n:21]), Group Ib (IVIG [n:6]), Group Ic (MP+IVIG [n:6]) and chronic ITP group was then divided into subgroups Group IIa (MP [n:5]) and Group IIb (IVIG [n:6]), depending on the treatment to be administered. In the study we found that post-treatment total peroxide and oxidative stress index (OSI) values declined significantly, relative to pre-treatment values (p<0.05), while total antioxidant capacity (TAOC) value increased significantly in acute ITP cases (p<0.001). In chronic ITP group we also established that total peroxide and OSI values after the treatment decreased significantly in comparison to those before the treatment (p<0.05), but the increase in TAOC value was not significant (p>005). In the totality of cases, we found that total peroxide and OSI values decreased significantly (p<0.05, p=0.001, respectively), while TAOC value increased significantly in the post-treatment period, relative to pre-treatment values (p=0.001). An examination of treatment modalities in acute ITP cases showed that total peroxide and OSI levels decreased significantly (p<0.05), and TAOC increased significantly after the treatment in the group which was administered IVIG (p<0.05). When treatment modalities in chronic ITP cases were examined, it was found that total peroxide and OSI levels decreased significantly (p<0.05) and TAOC increased significantly (p<0.05) after the treatment in the group which was administered MP. In conclusion, it is seen that oxidative stress can have a part in the pathogenesis of ITP. Oxidative stress is higher in chronic ITP. Measurement of plasma oxidant parameters at the onset of the disease can give an idea about whether the disease is acute or chronic. It is seen that IVIG treatment should be preferred in cases considered to have acute ITP and MP treatment in those considered to have chronic ITP. Key words: Immune thrombocytopenic purpura, methylprednisolone, intravenous immunoglobulin, oxidative stress, total antioxidant capacity.