Nokhostin Forogh, Bakhshpour Fatemeh, Pezeshki Seyed Mohammad Sadegh, Khademi Reyhane, Saki Najmaldin
Rheumatology Department, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Expert Rev Hematol. 2023 Jul-Dec;16(10):731-742. doi: 10.1080/17474086.2023.2255750. Epub 2023 Sep 8.
Immune thrombocytopenia [ITP] is a common bleeding disorder with an isolated platelet count of less than 100 × 10/L.
Relevant literature from 2003 to 2022 was retrieved and reviewed from the Google Scholar search engine and PubMed database. Antibodies produced by autoreactive B lymphocytes and the phagocytic function of macrophages are considered the most critical factors in platelet destruction. Also, macrophages present the antigen to T lymphocytes and activate them. Follicular helper T-cells [TFH] play a role in stimulating, differentiating, and activating autoreactive B cells, while cluster of differentiation [CD]-8+ T plays a role in platelet destruction through apoptosis. The classical pathway of the complement system also causes platelet destruction. By inhibiting platelet production, low levels of thrombopoietin and an immune response against megakaryocytes in the bone marrow worsen thrombocytopenia.
T-cell subset changes and an increase in activated autoreactive B cells, in addition to the function of components of the innate immune system [the complement system, dendritic cells, and natural killer cells], play a critical role in the pathogenesis of the ITP. Accurate detection of these changes may lead to developing new therapeutic strategies and identifying better prognostic/diagnostic factors.
免疫性血小板减少症（ITP）是一种常见的出血性疾病，其血小板计数单独低于100×10⁹/L。
从谷歌学术搜索引擎和PubMed数据库检索并回顾了2003年至2022年的相关文献。自身反应性B淋巴细胞产生的抗体和巨噬细胞的吞噬功能被认为是血小板破坏的最关键因素。此外，巨噬细胞将抗原呈递给T淋巴细胞并激活它们。滤泡辅助性T细胞（TFH）在刺激、分化和激活自身反应性B细胞中起作用，而分化簇（CD）-8⁺T细胞通过凋亡在血小板破坏中起作用。补体系统的经典途径也会导致血小板破坏。血小板生成素水平低以及针对骨髓中巨核细胞的免疫反应通过抑制血小板生成而使血小板减少症恶化。
T细胞亚群变化和活化的自身反应性B细胞增加，除了固有免疫系统（补体系统、树突状细胞和自然杀伤细胞）成分的功能外，在ITP的发病机制中起关键作用。准确检测这些变化可能会导致开发新的治疗策略并识别更好的预后/诊断因素。
