Helicobacter Pylori and it's Hematological Impact
Helicobacter Pylori and it's Hematological Impact
To evaluate the effect of helicobacter pylori on the blood for proper management
r pylori (H. pylori)is the most common infection in humans, with a marked disparity between
 developed and developing countries.It presents in over 50% of all stomachs in the world
 population, making it the most frequent infection in humanS. It displays a marked disparity
 in occurrence between developed countries, where its prevalence oscillates between 30% and
 50%, and developing countries, where its prevalence ranges between 80% and 90%.

 Although H. pylori infections are asymptomatic in most infected individuals, they are
 intimately related to malignant gastric conditions such as gastric cancer and gastric
 mucosa-associated lymphoid tissue (MALT) lymphoma and to benign diseases such as gastritis
 and duodenal and gastric peptic ulcers.

 Since it was learned that bacteria could colonize the gastric mucosa, there have been reports
 in the medical literature of over 50 extragastric manifestations involving a variety medical
 areas of specialization. These areas include cardiology, dermatology, endocrinology,
 gynecology and obstetrics, hematology, pneumology, odontology, ophthalmology,
 otorhinolaryngology and pediatrics, and they encompass conditions with a range of clear
 evidence between the H. pylori infection and development of the disease.

 This review focuses on hematologic diseases included in international consensus and
 management guides for H. pylori infection; specifically iron deficiency Anemia, vitamin B12
 (cobalamin) deficiency, immune thrombocytopenia, and extranodal marginal zone
 mucosa-associated lymphoid tissue lymphoma (MALT Lymphoma). In addition of other hematologic
 diseases not included in guides and consensus as auto-immune neutropenia, antiphospholipid
 syndrome, and plasma cell dyscrasias.

 Iron deficiency Iron deficiency (ID) is a serious public health issue, regardless of whether
 it is associated with anemia . It is especially important to remember that ID is a chronic
 process with a slow onset, in which the iron imbalance may take several years to establish
 and manifest clinically. One of the consequences can be observed through blood
 characteristics such as morphological alterations of erythrocytes or the presence of anemia,
 according to the criteria of the WHO.ID occurs in three stages: pre-latent (stage 1), in
 which ferritin is between 12 and 30 μg/L, latent (stage 2) when the ferritin falls below 12
 μg/L, and ID anemia (stage 3) when anemia is present in addition to diminished or depleted
 reservoir iron levels (determined by serum ferritin).

 Vitamin B12 deficiency Vitamin B12 is required as a coenzyme for the metabolism of the amino
 acids methionine, threonine and valine and for the transformation of methyl-tetrahydrofolate
 to tetrahydrofolate, which is necessary for DNA synthesis. Vitamin B12 deficiency, also known
 as cobalamin deficiency, is defined by low serum values of vitamin B12 and both homocysteine
 and methylmalonic acid (two components of the vitamin B12 metabolic pathway). Vitamin B12
 deficiency occurs as a result of antibodies directed against gastric parietal cells and
 intrinsic factor, in addition to achlorhydria and a decrease in pepsinogen I and gastrin.

 The laboratory diagnosis of vitamin B12 deficiency is established in accordance with the
 following criteria:

 1. serum vitamin B12 levels < 150 pmol/L (< 200 pg/mL) with clinical features and/or
 hematological anomalies related to vitamin B12 deficiency

 2. serum vitamin B12 levels < 150 pmol/L on two separate occasions .

 3. serum vitamin B12 levels < 150 pmol/L and total serum homocysteine levels > 13 μmol/L or
 methylmalonic acid levels > 0.4 μmol/L (in the absence of renal failure and folate and
 vitamin B6 deficiencies).

 4. serum holotranscobalamin levels < 35 pmol/L. Immune thrombocytopenia Primary immune
 thrombocytopenia (ITP), previously called idiopathic thrombocytopenic purpura and
 autoimmune thrombocytopenic purpura.ITP has been redefined as "an autoimmune disorder
 characterized by isolated thrombocytopenia (peripheral blood platelet count 100 × 109/L)
 in the absence of other causes or disorders that may be associated with
 thrombocytopenia.

 Primary ITP is associated with congenital or acquired immune disorders, leading to an
 autoimmune response against platelets or megakaryocytes and characterized because it is not
 associated with other alterations.

 Gastric MALT lymphoma Gastric MALT lymphoma is a rare form of non-Hodgkin lymphoma that
 affects B lymphocytes and typically develops in lymphoid tissue associated with mucous
 membranes and rarely in lymph nodes. It represents approximately 5% of all diagnosed
 non-Hodgkin lymphomas.

 The mechanisms by which H. pylori produces the appearance of a lymphoma similar to gastric
 carcinogenesis has not been fully clarified, but it is likely that environmental, host, and
 bacterial-related factors must be involved.H. pylori infection leads to development of MALT
 lymphoma and can take the following course. First, the infection gives rise to a lymphocyte
 response that conditions a polyclonal B lymphocyte response and MALT formation through
 antibody production. Then, different lymphocyte populations would maintain the response
 provoked by the bacteria. In the polyclonal MALT proliferation, a monoclonal population of
 B-cells could appear and accumulate cytogenetic changes such as translocations, mutations,
 microsatellite instabilities, eventually evolving into a low-grade MALT lymphoma that is
 dependent on H. pylori-related antigen stimuli. Finally, new cytogenetic changes such as
 translocations, suppressor gene deactivation (p53 and p16, among others), and c-myc
 activation would make this neoplastic population of monoclonal B-cells escape from its
 dependence on T lymphocytes and H. pylori antigens and favor its transformation into a
 high-grade lymphoma. As a result of this sequence of events, a low- or high-grade lymphoma
 would ultimately develop.

 UNRECOGNIZED HEMATOLOGIC MANIFESTATIONS This group includes autoimmune neutropenia,
 antiphospholipid syndrome, plasma cell dyscrasia including monoclonal gammopathy of
 undetermined significance and multiple myeloma.
Inclusion Criteria:

 -  All patients complained of symptoms suggestive of gastritis whether acute (within two
 weeks) or chronic (three or more months) and were diagnosed at endoscopy to have
 H.pylori infection by biopsy.

 -  Patients aged more than 18 years old.

 -  Both sexes (male & female).

 Exclusion Criteria:

 -  Patients with malignant diseases or Gastric malignancy.

 -  Other causes of Thrombocytopenia as systemic lupus erythematous and human
 immunodeficiency virus and or acquired immunodeficiency syndrome.

 -  Other causes of Anemias with or without blood loss.