Giovanni Emilia, MD; Mario Luppi, MD; Giuseppe Torelli, MD
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Emilia G, Luppi M, Torelli G. Helicobacter pylori and Idiopathic Thrombocytopenic Purpura. Ann Intern Med. 2004;141:820. doi: 10.7326/0003-4819-141-10-200411160-00017
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Published: Ann Intern Med. 2004;141(10):820.
TO THE EDITOR:
Franceschi and colleagues' interesting letter about the cross-reactivity between Helicobacter pylori and platelet antigens (1) contains some perplexities we would like to address. The authors reported that they re-investigated a group of patients from their 1998 study (2) whose platelet counts had increased “after eradication of CagA [cytotoxin-associated gene A]-positive H. pylori infection.” However, their 1998 paper does not mention anti-CagA antibodies (2). Did Franceschi and colleagues test archival specimens for them?
Franceschi and colleagues' letter also stated that “no patient received treatment for ITP [idiopathic thrombocytopenic purpura].” Since the authors said in their previous paper that patients had been given steroids (2), it is important to know when and how long steroids were administered. Similarly, it is not clear when and from which material the platelet lysates of the 6 patients who were responsive to H. pylori eradication therapy were isolated. Again, are the 6 patients “with active and untreated ITP” new patients? Franceschi and colleagues stated that “before therapy, 5 of these 11 patients had anti–glycoprotein (GP) IIb/IIIa antibodies” and that “no changes in antibody levels were observed.” In their previous paper, in the same patients, the authors stated that antiplatelet autoantibodies disappeared in 6 of 8 patients (2). Do these seeming discrepancies result from different antibodies or different observations? Also, in Franceschi and colleagues' Figure, the presence of a gel artifact for 1 of the controls (patient F) makes evaluation of the control data problematic. Have the controls been investigated for H. pylori infection?
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