Alteration of T-cell and monocyte subsets in patients with immune thrombocytopenia: glucocorticoids versus immunosuppressant drugs

Background Several therapy approaches are currently in use, each focusing on a different element of primary immune thrombocytopenia (ITP) pathogenesis. Human T-lymphocytes and monocytes are heterogeneous and play an important role in autoimmune diseases. However, the distribution and function of mononuclear cells remain unclear in ITP after therapy. Aim To evaluate the effect of glucocorticoid hormones and other immunosuppressant drugs in patients with ITP on lymphocyte and monocyte subsets and correlate changes between drug responders and nonresponders. Patients and methods A randomized cross-sectional case-control study was conducted on 130 participants, who were divided into two groups: 50 patients with ITP and 80 healthy controls. The patients were randomly treated with either steroids, azathioprine, or revolade in the Department of Internal Medicine of Qena University Hospital between April 2021 and April 2022. The research was conducted at the Department of Clinical Pathology of Qena University Hospital. Results Treatment with steroids, azathioprine, or revolade showed increased CD3-expressing cells and improved platelets and platelet/lymphocyte ratios. Steroid therapy also increased hemoglobin levels, leukocyte numbers, neutrophil counts, monocyte counts, and monocyte-lymphocyte ratios. Leukocyte count was increased by azathioprine treatment, whereas leukocyte, neutrophil, and monocyte/lymphocyte counts were increased by revolade treatment. Azithromycin and revolade therapy decreased CD14 count and increased CD16 fraction. Azithromycin treatment increased CD4 cells, whereas steroid treatment boosted CD8 cells. Additionally, in comparison with controls, patients had considerably less classical monocytes. However, patients had significantly more nonclassical monocytes and intermediate than controls did. Nonclassical and intermediate monocytes showed a significant reduction. Treatment responders were much older than nonresponders. The hazard ratio of monocyte/lymphocyte ratio was 0.002 (95% confidence interval: 0-0.55) and for neutrophil/lymphocyte ratio was 1.82 (95% confidence interval: 1.04-3.16), with P values of 0.04 and 0.03, respectively. Conclusion The modification of monocytes and lymphocytes in ITP following treatment can provide insight into the significance of these cells and the likelihood of using it to monitor patients while they are receiving treatment.