Efficiency of hypoxic hypoxia during idiopathic thrombocytopenic purpura
Abduhalim R. Raimzhanov1, Irina A. Tsopova2, Mary O. Eralieva1, Bahtygul K. Aysarieva3
1 Kyrgyz Scientific Center of Hematology
2 Kyrgyz-Russian Slavic University, Bishkek, Kyrgyzstan
3 Osh Regional Hospital, Osh, Kyrgyzstan
To provide available medical assistance to the patients with idiopathic thrombocytopenic purpura (ITP).
Patients and Methods
We have applied high-altitude climate therapy (HACT) as an alternative to conventional methods of treatment of ITP. Generally, this approach creates conditions of chronic hypoxic hypoxia for the patient over 40 days, using a following schedule: travelling up to a height of 3200 m above the sea level; bed rest (1 to 5 days); semi-strict bed rest (5 to 7 days); increased physical activity (7 to 20 days); mountain walks (20-40 days). We studied the data of the performance-induced platelet functions with a “Biola” aggregometer; evaluation of IL-2, IL-6 and tumor necrosis factor (TNF) by means of ELISA testing (manufactured by the “Protein Contour”). The study involved 24 patients with ITP. The 1st group consisted of 14 patients in remission state who received only high-altitude climatotherapy; the 2nd group included 10 patients with ITP, who received hormonal therapy in the foothill region, and continued this treatment at the high altitude. We evaluated both clinical and hematological improvement, and long-term outcomes.
When studying platelet aggregation in patients with ITP at the altitude of 760 m , a sharp decrease of ADP-induced aggregation was revealed (20% versus 82% in healthy persons). Upon adaptation to high altitudes, the changes in platelet aggregation were registered from the 20th day of HACT. They included increase in the platelet aggregation, as shown with ristomycin, collagen and ADP, by 3,2, 2,7 and 2,3-fold increase (p<0,05) in the 1st group of ITP patients, and 3,6, 3,4 and 3,0-fold acceleration (p<0,05) in the 2nd group. The 1,3-fold increase of ADP-induced platelet aggregation was observed on the 20th day of the therapy, and on 40th day such increase was 1,5 times in the both ITP groups (p<0,05). A similar pattern was observed with other aggregation inducers. Initial concentrations of IL-6 in ITP patients exceeded the levels of healthy persons by 6.0 times (1st group) and 3,2 times (2nd group) (P<0,001). During HACT there was a significant (4-fold) decrease of its levels in the both groups. The IL-2 levels upon initial examination were 346,9±23 pg/ml in group 1, and 1264,2±31 pg/ml in the 2nd group, as compared with 92,0±14,8 pg/ml in healthy persons. By the day 40 of the study, the levels of IL-2, which showed a 2-fold decrease in both groups by the day 20, increased in group 1, however, remaining 1,5-fold below the initial values (p<0,001). Among the 2nd group of ITP patients, the levels of this cytokine after adaptation for the high altitude were significantly reduced by 3,6 times against initial values. TNF values during the high-altitude therapy decreased among the patients of 1st group by 2,9 times on the day 20 of treatment (p<0,001), and 2,7-fold in the 2nd group (p<0,001), remaining unchanged by the end of adaptation. Stabilization of the platelet functions (both quantitatively and qualitatively) among the ITP patients under the influence of high-altitude climatotherapy is retained after the descent up to 3 months for ITP patients in the 2nd group, and up to 6 months among the patients in the 1st group. Hemorrhagic syndrome was documented in 20% of cases of ITP patients (1st group) before HACT treatment. On the day 40 of altitude adaptation, the local bleedings were not observed, and average platelet counts increased from 35 to 109 ×109/l. All the patients from the 2nd group, except of 4 cases, exhibited hemorrhagic signs before the mountain travel. The level of platelets among them was critical (12,2 to 18,0×109/l). After HACT, these levels increased to a mean of 62,8×109/l, and hemorrhagic syndrome faded away.
Hence, a stress situation produced at high altitudes, along with activation and release of adrenal glucocorticoids, may potentially induce a destructive effect upon anti-platelet antibodies in the ITP patients. A possible immunomodulatory effect of high-altitude hypoxia may suppress synthesis of pro-inflammatory cytokines, promote their return to the balanced state, as reflected by improvement of clinical pattern and seems to be favorable to clinical outcomes, when using HACT as an alternative therapeutic method for the patients with this disease.
Idiopathic thrombocytopenic purpura, high-altitude climatotherapy, aggregation, interleukin, long-term outcomes