الفهرس 
? Chronic Immune ThrombocytopeniaOnly 14 pages are availabe for public view
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Abstract
Background: Immune thrombocytopenia (ITP) in children is usually a short self-limiting disease with favorable prognosis characterized by increased platelet destruction and decreased platelet number. However, the condition can become chronic in 5% to 30% of affected children. It may be triggered by viral infection as many reports documenting the relationship of viral infections with ITP. HCMV infection may result in severe, refractory ITP. Treatment with steroids was shown to worsen the course of HCMV-associated ITP. Aim: To assess the effect of CMV infection on the course of ITP and to evaluate the effect of CMV positivity on the INF γ and its impact on bleeding manifestations and outcome in patients with ITP. Methods: A cross sectional study; in patients aged 1-18 years with chronic ITP. Thirty-seven patients with chronic ITP were enrolled in the study. HCMV IgM, IgG and IFN γ by flow cytometry were done for each patient with chronic ITP. HCMV IgG avidity was assessed in HCMV IgM positive cases. Results: the frequency of HCMV IgM positive was 35.1% of pediatrics patients with chronic ITP. All our patients with chronic ITP showed HCMV IgG positivity and all HCMV IgM positive patients showed high HCMV IgG avidity. Significant higher IFN gamma levels were observed in patients with chronic ITP compared with control group (P<0.001). There was negative correlation between INF gamma and HCMV IgG avidity. HCMV IgM positive cases did not differ from HCMV IgM negative cases according to age, gender, history of viral illness, clinical presentation, SMOG score, blood picture and platelet count at the time of diagnosis. Response to initial treatment was similar in both HCMV IgM positive patients and CMV IgM negative patients (p=0.466). However, duration of response to treatment to first line of treatment was longer in patients with HCMV IgM negative compared to HCMV IgM positive patients (P=0.043). The differences in response to current treatment were not statistically significant (P=0.399). Conclusion: active CMV infection is not uncommon in children with ITP. However, CMV reactivation didn’t seem to have an appreciable impact on the clinical course and the response to treatment on children with ITP. In addition, High level of IFN gamma may play role in its pathophysiology.