الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Immune Thrombocytopenic purpura known as autoimmune disease caused by antibodies against self-antigens leading to platelet destruction in the absence of bone marrow affection or other cause of thrombocytopenia. The most common autoantibodies are directed to platelet membrane glycoprotein (GP) IIbIIIa or GPIb-IX. Which play a major role in platelets destruction and decrease in platelets count less than 100,000/cmm. As regard ITP classification, it classified either according to cause into primary and secondary ITP, secondary ITP may be due to infection or vaccines and endocrinal causes. Or classified according to duration to newly diagnosed ITP, persistent ITP, and chronic ITP. Newly diagnosed ITP is defined as disease within three months of the onset of diagnosis ,persistent ITP is disease with a duration between 3 to 12 months and chronic ITP is define as thrombocytopenia continuing beyond one year. In a systematic review, global prevalence of ITP is 1.6 to 3.9 per 100,000 patient-years, females are more affected than males. The mortality rate from hemorrhage is approximately 1% in children and 5% in adults in patients with severe thrombocytopenia. The B-Cell-Activating Factor (BAFF) is a member of the tumor necrosis factor (TNF) superfamily which are the key actors for the B-cell survival and the immune responses concerning mature B-cells. As TNF family member, B cell-activating factor is essential for generation and maintenance of the mature B cell pool. BAFF is expressed on many cells like macrophage, monocyte and dentric cell, and its expression pattern may control the compartmentalization of B cells in the peripheral immune system, such as the localization of B cells to B cell follicles. Therefore, the aim of the study was to assess the role of B-cell-activating factor (BAFF) in the primary immune thrombocytopenia. The present study was conducted on 90 subjects divided into 2 groups: group I includes 45 patients with primary ITP and group II includes 45 healthy volunteers as control group. The patients were recruited from Hematology Unit, Internal Medicine Department, Tanta university hospitals in the period between,” May 2021 to May 2022 ”. The patients, demographic, clinical, laboratory and radiological data were recorded in a special observation sheet. The laboratory investigations including complete blood count (CBC) with blood film, Thyroid stimulating hormone (TSH), Anti-nuclear antibody (ANA), hepatitis B virus antigen (HBsAg),hepatitis C virus antibody (HCV-Ab), human immunodeficiency viruses antibody (HIV-Ab),Liver function tests (direct and indirect bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and serum albumin),Helicobacter pylori antigen in stool (H.pylori), blood urea and serum creatinine, bone marrow a sprit (BMA) in some cases and the specific laboratory investigation was the measurement of B-Cell-Activating Factor (BAFF) levels by (ELISA technique) Additionally, radiological assessment in form of pelvi-abdomnal ultrasound searching for splenomegaly. Data were statistically analyzed, and the result of this study revealed that: BAFF level was significantly higher in ITP patients than control group. As regarding response to therapy, our findings revealed that serum BAFF level was significantly higher in newly diagnosed ITP cases and consider significantly lower in patients who were completely responsive to treatment, whereas patients who were resistant to treatment had much significant higher levels of BAFF. BAFF was positively correlated with MPV, PDW and LDH. BAFF was negatively correlated with platelet count. ROC carve demonstrating that :- • Serum BAFF at cut off value of 141.21; had a sensitivity was 95.6%, specificity 82.2%, positive predictive value (PPV) 84.3%, and negative predictive value (NPV) 94.9% with area under the curve was 0.848, to diagnose ITP and to differentiate cases from control. • Serum BAFF at cut off value of 238.27; had a sensitivity was 93.8%, specificity 75.9%, positive predictive value (PPV) 79.24%, and negative predictive value (NPV) 91.89% with area under the curve was .858, to predict response to treatment ITP and to differentiate ITP responder cases from non-responder . • Serum BAFF at cut off value of 201.01; had a sensitivity 95%, specificity 80%, positive predictive value (PPV) 79.16%, and negative predictive value (NPV) 95.23% with area under the curve was .888, to predict response to steroid.