Features of the subpopulation composition and functional activity of peripheral blood lymphocytes and monocytes in patients with primary autoimmune thrombocytopenia

Background. Primary immune thrombocytopenia (ITP) is an immune-mediated disease characterized by platelet destruction and impaired thrombopoiesis with the development of varying severity hemorrhagic syndrome. The first line of therapy for ITP patients are glucocorticosteroids, which have limited efficacy and frequent complications. Factors of innate and adaptive immunity play a key role in ITP pathogenesis, the study of which is especially relevant for assessing the immunological reactivity of patients and substantiating new therapeutic approaches in real clinical practice.
Aim. To evaluate the characteristics of the subpopulation composition and functional activity of peripheral blood lymphocytes and monocytes in ITP patients and to identify possible immunological prognostic criteria for the disease course and resistance to glucocorticosteroid therapy.
Materials and methods. In 20 patients with newly diagnosed ITP and in 20 ITP patients with resistance to glucocorticosteroid therapy, the relative and absolute parameters of T-lymphocytes (CD3+), B-lymphocytes (CD19+), NK cells (CD3–CD16+CD56+), T-helper cells (CD3+CD4+), T-cytotoxic (CD3+CD8+) and NKT (CD3+CD16+CD56+) subpopulations of peripheral blood lymphocytes, as well as the expression of HLA-DR on lymphocytes and monocytes, CD25 on CD4+ T-lymphocytes and CD40 on B -lymphocytes were analyzed using flow cytometry. Thirty healthy individuals were examined as a control group.
Results. In patients with newly diagnosed ITP, a sharp decrease in the absolute number of B cells and T-helper lymphocytes in peripheral blood was observed, and pronounced activation of T-lymphocytes by HLA-DR expression and B-lymphocytes by costimulatory molecule CD40 expression was noted. In patients with glucocorticosteroids resistance, a significant decrease in the absolute number of peripheral blood T-helper lymphocytes, an increase in the content of activated CD3+HLA-DR+ lymphocytes were also detected, but the level of CD40+ B-lymphocytes was reduced compared to primary patients.
In patients of both groups, a significant (p <0.001) decrease in HLA-DR mean fluorescence intensity on peripheral blood monocytes was detected, which may indicate an insufficient ability of monocytes and macrophages to effectively antigen processing.
Conclusion. Patients with ITP have been found to have significant disturbances in the quantitative parameters of cellular adaptive immunity and the functional activity of peripheral blood lymphocytes and monocytes, which play an important role in the immunopathogenesis of the disease.

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