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

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/RITP).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 NDITP/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.