The caspase-dependent cell death pathway in the platelets may play a role in the development of immune thrombocytopenia (ITP), according to a new study published in the Indian Journal of Hematology and Blood Transfusion. The apoptotic changes are heterogenous in children with newly diagnosed ITP who receive intravenous immunoglobulin (IVIG) or methylprednisolone, the study also reported.

The authors said future studies should include more apoptotic markers to strengthen their findings.

Read more about the pathophysiology of ITP

To evaluate the potential role of apoptosis in ITP pathogenesis, a team of researchers from Egypt led by Yahya Wahba, MD, from the Mansoura University Faculty of Medicine, evaluated the levels of the apoptotic markers caspase 3, caspase 8, and B-cell lymphoma protein 2 (BCL2) in 60 children with newly diagnosed ITP. They compared these to levels in 20 children with chemotherapy-related thrombocytopenia and 20 healthy children. 

The team also investigated the effect of IVIG and methylprednisolone treatment on the apoptosis of platelets in children with newly diagnosed ITP.

The results showed that the levels of caspase 3 were significantly higher in children with newly diagnosed ITP compared to those with chemotherapy-related thrombocytopenia and those who were healthy. The levels of caspase 8 were also higher in children with ITP compared to the others, but this was not significant. 

Following IVIG treatment, the platelet count increased in all children. The levels of caspase 3 and caspase 8, on the other hand, decreased significantly following the treatment. However, the levels of BCL2 increased. 

Caspase 8 levels also decreased following methylprednisolone treatment, as did BCL2 levels, but there was no significant decrease in the levels of caspase 3.

“There is a possible role of the caspase-dependent cell death pathway of the platelets in the occurrence of newly diagnosed ITP,” the researchers concluded.


Yahia S, Eldars W, Eldegla H, et al. Cell death markers in children with immune thrombocytopenic purpura: a preliminary study. Indian J Hematol Blood Transfus. Published online February 25, 2023. doi:10.1007/s12288-023-01639-0