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The Egyptian Journal of Internal Medicine
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Helicobacter pylori and its hematological effect

The Egyptian Journal of Internal Medicine volume 31, pages 332–342 (2019)Cite this article

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Abstract

Background

Helicobacter pylori causes several gastric, intestinal, and extraintestinal manifestations. It also causes persistent infection and can cause serious various hematological effects.

Aims

To investigate the hematological effect of H. pylori infection.

Patients and methods

This is a cohort study that included 50 adult (age range: 18–75 years) patients infected with H. pylori and 50 adult patients who presented with symptoms suggestive of gastritis. All patients underwent upper endoscopy, and biopsies were taken. Moreover, the patients underwent complete blood count, iron studies, hepatitis C virus antibodies, vitamin B12 level, and bone marrow aspirate.

Result

The results showed that hemoglobin level, serum iron level, vitamin B12 levels, and platelets count were much lower in patients infected with H. pylori than the control group.

Conclusion

H. pylori causes iron-deficiency anemia, vitamin B12 deficiency, and thrombocytopenia, and treatment of H. pylori causes much improvement in these parameters.

References

  1. Sánchez Delgadoa J, García-Iglesias P, Titó L, Puigd I, Planellaf M, Genéb E et al. Update on the management of Helicobacter pylori infection. Gastroenterol Hepatol 2018; 41:272–280.

    Google Scholar 

  2. Stolte M, Bayerdörffer E, Morgner A, Alpen B, Wündisch T, Thiede C, Neubauer A. Helicobacter and gastric MALT lymphoma. Gut 2002; 50(Suppl 3):III19–III24.

    PubMed  PubMed Central  Google Scholar 

  3. Goodnough LT, Nemeth E, Greer JP, Arber DA, Glader B, List AF et al. Wintrobe’s clinical hematology. 13th ed. Philadelphia, PA: Lippincott Williams & Wilkins 2013. 617–642

    Google Scholar 

  4. Ge R, Sun X. Iron trafficking system in Helicobacter pylori. Biometals 2012; 25: 247–258.

    CAS  PubMed  Google Scholar 

  5. Pentti Sipponen and Heidi-Ingrid Maaroos. Chronic gastritis. Scandinavian Journal of Gastroenterology. 2015; 50:657–667. PMCID: PMC4673514, PMID: 25901896

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Campuzano-Maya G. Hematologic manifestations of Helicobacter pylori infection. World J Gastroenterol 2014; 20: 12818–12838.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Akada JK, Aoki H, Torigoe Y, Kitagawa T, Kurazono H, Hoshida H et al. Helicobacter pylori CagA inhibits endocytosis of cytotoxin VacA in host cells. Dis Model Mech 2010; 3: 605–617.

    CAS  PubMed  Google Scholar 

  8. Bridge DR, Merrell DS. Polymorphism in the Helicobacter pylori CagA and VacA toxins and disease. Gut Microbes 2013; 4: 101–117.

    PubMed  PubMed Central  Google Scholar 

  9. Mwafy SN, Afana WM. Hematological parameters, serum iron and vitamin B12 levels in hospitalized Palestinian adult patients infected with Helicobacter pylori. Hematol Transfus Cell Ther 2018; 40: 160–165.

    PubMed  PubMed Central  Google Scholar 

  10. Dali-Youcef N, Andrès E. An update on cobalamin deficiency in adults. QJM 2009; 102: 17–28.

    CAS  PubMed  Google Scholar 

  11. British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003; 120:574–596.

    Google Scholar 

  12. Franchini M, Cruciani M, Mengoli C, Pizzolo G, Veneri D. Effect of Helicobacter pylori eradication on platelet count in idiopathic thrombocytopenic purpura: a systematic review and meta-analysis. J Antimicrob Chemother 2007; 60: 237–246.

    CAS  PubMed  Google Scholar 

  13. Houghton AR, David G. Chamberlain’s symptoms and signs in clinical medicine. 13th ed. CRC Press; 2010.

  14. Arnold DM, Bernotas A, Nazi I, Stasi R, Kuwana M, Liu Y et al. Platelet count response to H. pylori treatment in patients with immune thrombocytopenic purpura with and without H. pylori infection: a systematic review. Haematologica 2009; 94: 850–856.

    PubMed  PubMed Central  Google Scholar 

  15. NHLBI, NIH. How is thrombocytopenia diagnosed? Available at: www.nhlbi.nih.gov. [Accessed May 19 2015].

  16. Schwarz S, Morelli G, Kusecek B, Manica A, Balloux F, Owen RJ et al. Horizontal versus familial transmission of Helicobacter pylori. PLoS Pathog 2008; 4: e1000180.

    PubMed  PubMed Central  Google Scholar 

  17. Bruce MG, Maaroos HI. Epidemiology of Helicobacter pylori infection. Helicobacter 2008; 13(Suppl 1):1–6.

    PubMed  Google Scholar 

  18. Xu MY, Cao B, Yuan BS, Yin J, Liu L, Lu QB. Association of anaemia with Helicobacter pylori infection: a retrospective study 2017; 7: 13434. PMID: 29044219 PMCID: PMC5647388 DOI: https://doi.org/10.1038/s41598-017-13955-3

    Google Scholar 

  19. de Martel C, Parsonnet J. Helicobacter pylori infection and gender: a meta-analysis of population-based prevalence surveys. Dig Dis Sci 2006; 51: 2292–2301.

    PubMed  Google Scholar 

  20. Linz B, Balloux F, Moodley Y, Manica A, Liu H, Roumagnac P et al. An African origin for the intimate association between humans and Helicobacter pylori. Nature 2007; 445: 915–918.

    PubMed  PubMed Central  Google Scholar 

  21. Kodaman N, Pazos A, Schneider BG, Piazuelo MB, Mera R, Sobota RS et al. Human and Helicobacter pylori coevolution shapes the risk of gastric disease. Proc Natl Acad Sci U S A 2014; 111: 1455–1460.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Gupta V, Eden AJ, Mills MJ. Helicobacter pylori and autoimmune neutropenia. Clin Lab Haematol 2002; 24: 183–185.

    CAS  PubMed  Google Scholar 

  23. Papadaki HA, Pontikoglou C, Stavroulaki E, Minadakis G, Eliopoulos DA, Pyrovolaki K et al. High prevalence of Helicobacter pylori infection and monoclonal gammopathy of undetermined significance in patients with chronic idiopathic neutropenia. Ann Hematol 2005; 84: 317–320.

    PubMed  Google Scholar 

  24. Papadaki HA, Pontikoglou C, Eliopoulos DG, Pyrovolaki K, Spyridaki R, Eliopoulos GD. Helicobacter pylori infection is probably the cause of chronic idiopathic neutropenia (CIN) associated splenomegaly. Am J Hematol 2006; 81: 142–144.

    PubMed  Google Scholar 

  25. Gheibi S, Noroozi M, Hejazi S, Karamyyar M, Farrokh-Eslamlou H. Severe anemia and Helicobacter pylori infection in school age children; a case reports. Iran J Ped Hematol Oncol 2016; 6: 64–69.

    PubMed  PubMed Central  Google Scholar 

  26. DeLoughery TG. Microcytic anemia. N Engl J Med 2014; 371: 1324–1331.

    PubMed  Google Scholar 

  27. Mubarak N, Gasim GI, Khalafalla KE, Ali NI, Adam I. Helicobacter pylori, anemia, iron deficiency and thrombocytopenia among pregnant women at Khartoum, Sudan. Trans R Soc Trop Med Hyg 2014; 108: 380–384.

    CAS  PubMed  Google Scholar 

  28. Queiroz DM, Rocha AM, Crabtree JE. Unintended consequences of Helicobacter pylori infection in children in developing countries. Gut Microbes 2013; 4: 494–504.

    PubMed  PubMed Central  Google Scholar 

  29. Xia W, Zhang X, Wang J, Sun C, Wu L. Survey of anaemia and Helicobacter pylori infection in adolescent girls in Suihua, China and enhancement of iron intervention effects by H. pylori eradication. Br J Nutr 2012; 108: 357–362.

    CAS  PubMed  Google Scholar 

  30. Senkovich O, Ceaser S, McGee DJ, Testerman TL. Unique host iron utilization mechanisms of Helicobacter pylori revealed with iron-deficient chemically defined media. Infect Immun 2010; 78: 1841–1849.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Hershko C, Ronson A. Iron deficiency, Helicobacter infection and gastritis. Acta Haematol 2009; 122: 97–102.

    CAS  PubMed  Google Scholar 

  32. Rad R, Schmid RM, Prinz C. Helicobacter pylori, iron deficiency, and gastric autoimmunity. Blood 2006; 107: 4969–4970.

    CAS  PubMed  Google Scholar 

  33. Wians FH, Urban JE, Keffer JH, Kroft SH. Discriminating between iron deficiency anemia and anemia of chronic disease using traditional indices of iron status vs transferrin receptor concentration. Am J Clin Pathol 2001; 115: 112–118.

    CAS  PubMed  Google Scholar 

  34. Rockey DC, Cello JP. Evaluation of the gastrointestinal-tract in patients with iron-deficiency anemia. N Engl J Med 1993; 329: 1691–1695.

    CAS  PubMed  Google Scholar 

  35. Vannella L, Lahner E, Osborn J, Annibale B. Systematic review: gastric cancer incidence in pernicious anaemia. Aliment Pharmacol Ther 2013; 37: 375–382.

    CAS  PubMed  Google Scholar 

  36. Andrès E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ 2004; 171: 251–259.

    PubMed  PubMed Central  Google Scholar 

  37. Saito M, Mori A, Irie T, Tanaka M, Morioka M. Helicobacter pylori infection is not associated with pernicious anemia in Japan. Rinsho Ketsueki 2008; 49: 1569–1571.

    PubMed  Google Scholar 

  38. Kaptan K, Beyan C, Ural AU, Cetin T, Avcu F, Gülşen M et al. Helicobacter pylori is it a novel causative agent in Vitamin B12 deficiency? Arch Intern Med 2000; 160: 1349–1353.

    CAS  PubMed  Google Scholar 

  39. Payne RW. Pernicious anaemia and gastric cancer in England and Wales. Br Med J 1961; 1: 1807–1809.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Sato R, Murakami K, Okimoto T, Watanabe K, Kodama M, Fujioka T. Development of corpus atrophic gastritis may be associated with Helicobacter pylori-related idiopathic thrombocytopenic purpura. J Gastroenterol 2011; 46: 991–997.

    PubMed  Google Scholar 

  41. Pellicano R, Franceschi F, Saracco G, Fagoonee S, Roccarina D, Gasbarrini A. Helicobacters and extragastric diseases. Helicobacter 2009; 14(Suppl 1):58–68.

    PubMed  Google Scholar 

  42. Scandellari R, Allemand E, Vettore S, Plebani M, Randi ML, Fabris F. Platelet response to Helicobacter pylori eradication therapy in adult chronic idiopathic thrombocytopenic purpura seems to be related to the presence of anticytotoxin-associated gene A antibodies. Blood Coagul Fibrinolysis 2009; 20: 108–113.

    CAS  PubMed  Google Scholar 

  43. Takahashi T, Yujiri T, Shinohara K, Inoue Y, Sato Y, Fujii Y et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol 2004; 124: 91–96.

    CAS  PubMed  Google Scholar 

  44. Frydman GH, Davis N, Beck PL, James G. Helicobacter pylori eradication in patients with immune thrombocytopenic purpura: a review and the role of biogeography. Helicobacter 2015; 20: 239–251.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Noonavath RN, Lakshmi CP, Dutta TK, Kate V. Helicobacter pylori eradication in patients with chronic immune thrombocytopenic purpura. World J Gastroenterol 2014; 20: 6918–6923.

    PubMed  PubMed Central  Google Scholar 

  46. Michel M, Cooper N, Jean C, Frissora C, Bussel JB. Does Helicobacter pylori initiate or perpetuate immune thrombocytopenic purpura? Blood 2004; 103: 890–896.

    CAS  PubMed  Google Scholar 

  47. Ahn ER, Tiede MP, Jy W, Bidot CJ, Fontana V, Ahn YS. Platelet activation in Helicobacter pylori-associated idiopathic thrombocytopenic purpura: eradication reduces platelet activation but seldom improves platelet counts. Acta Haematol 2006; 116: 19–24.

    PubMed  Google Scholar 

  48. Gong Y, Wei W, Jingwei L, Nannan D, Yuan Y. Helicobacter pylori infection status correlates with serum parameter levels responding tomulti-organfunctions. Dig Dis Sci 2015; 60: 1748–1754.

    CAS  PubMed  Google Scholar 

  49. Ciortescu I, Sfarti C, Stan M, Graur M, Stanciu C. Prevalence of Helicobacter pylori infection in patients with diabetes mellitus. Rev Med Chir Soc Med Nat Iasi 2009; 113: 1048–1055.

    PubMed  Google Scholar 

  50. Krause I, Anaya JM, Fraser A, Barzilai O, Ram M, Abad V et al. Anti-infectious antibodies and autoimmune-associated autoantibodies in patients with type I diabetes mellitus and their close family members. Ann N Y Acad Sci 2009; 1173: 633–639.

    CAS  PubMed  Google Scholar 

  51. Gunji T, Matsuhashi N, Sato H, Fujibayashi K, Okumura M, Sasabe N et al. Helicobacter pylori infection is significantly associated with metabolic syndrome in the Japanese population. Am J Gastroenterol 2008; 103: 3005–3010.

    CAS  PubMed  Google Scholar 

  52. Wang SZ, Shi YN, Zhao J, Wang ZD. Effects of Helicobacter pylori on blood glucose fluctuation in type 2 diabetic patients. Zhonghua Yi Xue Za Zhi 2009; 89: 958–961.

    CAS  PubMed  Google Scholar 

  53. Eshraghian A, Hashemi SA, Hamidian Jahromi A, Eshraghian H, Masoompour SM, Davarpanah MA et al. Helicobacter pylori infection as a risk factor for insulin resistance. Dig Dis Sci 2009; 54: 1966–1970.

    PubMed  Google Scholar 

  54. Eyermann M, Rothenbacher D, Brenner H. Acquisition of Helicobacter pylori infection in early childhood: independent contributions of infected mothers, fathers, and siblings. Am J Gastroenterol 2009; 104: 182–911.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Faculty of Medicine, Department of Internal Medicine, Gastroenterology Unit and Clinical Hematology Unit, Assiut University, Assiut, Egypt

    Yousryeia Abdel Rahman

  2. Internal Medicine & Clinical Hematology, Assiut University, Assiut, Egypt

    Lobna Abdel wahid Ahmed

  3. Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt

    Rania Mohamed Mahmoud Hafez

  4. Gastroenterology Unit of Internal Medicine Departement, Faculty of Medicine, Assiut University, Assiut, Egypt

    Rasha Mohamed Mahmoud Ahmed Master Degree (Assistant Lecturer)

Authors
  1. Yousryeia Abdel Rahman
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  2. Lobna Abdel wahid Ahmed
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  3. Rania Mohamed Mahmoud Hafez
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  4. Rasha Mohamed Mahmoud Ahmed Master Degree
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Corresponding author

Correspondence to Rasha Mohamed Mahmoud Ahmed Master Degree.

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Rahman, Y.A., Ahmed, L.A.w., Hafez, R.M.M. et al. Helicobacter pylori and its hematological effect. Egypt J Intern Med 31, 332–342 (2019). https://doi.org/10.4103/ejim.ejim_103_18

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  • DOI: https://doi.org/10.4103/ejim.ejim_103_18

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