Triple Therapy in Patients With Idiopathic Thrombocytopenic Purpura : What is Behind?

Idiopathic thrombocytopenic purpura (ITP) is a benign hematological disorder characterized by isolated thrombocytopenia. Development of antiplatelet autoantibodies is the main pathogenetic mechanism in patients with ITP. However the exact pathogenesis of ITP is complex in which megakaryocyte immune injury and T-cell mediated platelet destruction play significant role. Accordingly treatment of ITP relies mainly on immunosuppression. Recently triple regimen of high dose dexamethasone together with cyclosporine and rituximab was found to induce prolonged remission in patients with ITP compared with single agent immunosuppression. On the other hand this regimen suppresses all immune cells thus predisposing patient to serious infections, which is the main cause of morbidity in ITP furthermore infection enhances autoimmunity. This study will focus on viral hepatitis C and B infection in Egyptian patients with idiopathic thrombocytopenic purpura on Triple therapy and aims to: * Assess and improve preventive measures of blood born hepatitis infection in the hematology ward in Egypt. * Investigate influence of immunosuppression on infection with blood born hepatitis on Egyptian patients with ITP on Triple therapy. * Study the impact of blood born hepatitis infection on clinical outcome on those patients. * Identify risk factors and routes of transmission of blood born viral hepatitis in the hematology ward in Egypt