scholarly journals Splenectomy during cesarean section in a patient with severe idiopathic thrombocytopenic purpura (ITP) refractory to the medical treatment

2014 ◽  
Vol 61 (4) ◽  
pp. 64-66
Author(s):  
Andreja Glisic ◽  
Aleksandar Cetkovic ◽  
Slavko Matic ◽  
Milos Petronijevic ◽  
Ivo Elezovic

Idiopathic thrombocytopenic purpura (ITP) is a disease of women of reproductive age and accounts for 5% of pregnancy associated thrombocytopenia. We reported the case of 21-year-old primigravida with ITP who was admitted to our hospital at the 28th weeks of gestation with platelet count of 22x109/l. Despite medicament treatment (prednisone, intravenous immunoglobulin /IgG/) there were falls in the platelet count, last at the 33rd week of gestation when platelet count was 15x109/l. In consultation with hematologist and surgeon we decided to deliver the patient by cesarean sec- tion during which splenectomy will be done. Patient received 60g of intravenous IgG two days before operations which were performed at the 34th week of gestation. Healthy female infant was born with normal platelet count and maternal platelet count at the discharge from hospital was 346x109/l.

Blood ◽  
1961 ◽  
Vol 18 (1) ◽  
pp. 73-88 ◽  
Author(s):  
SIDNEY L. SALTZSTEIN

Abstract Accumulation of a lipid, histochemically a phospholipid, in the histiocytes of the splenic pulp was observed in seven patients with thrombocytopenic purpura. Six had classical idiopathic thrombocytopenic purpura with abundant megakaryocytes in the bone marrow. Splenectomy resulted in clinical and hematologic remissions in four of these six, continued thrombocytopenia in the fifth, and in the continued requirement of corticosteroid to maintain a reasonably normal platelet count in the sixth. The seventh patient, who died shortly after splenectomy, had marked hypoplasia of megakaryocytes. Similar lipid accumulation was not seen in more than 700 other spleens, removed for a variety of reasons, reviewed in this study. Platelet phagocytosis has been suggested as a source of the lipid.


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2895-2895
Author(s):  
Gail A. Rock ◽  
David Anderson ◽  
Barrett Benny ◽  
David Barth ◽  
William Clark ◽  
...  

Abstract Introduction The ultimate therapy for TTP is not yet defined. While approximately 85% of patients respond to plasma exchange with FFP, the use of alternative solutions such as cryosupernatant plasma, which is deficient in the high molecular weight forms of vWF. has not been proven by appropriate randomized prospective sample trials. However, it is intellectually appealing. Additionally, the use of the ADAMTS 13 level either to predict disease or outcome has not been resolved. Methods Cryosupernatant plasma (CSP) was compared to solvent detergent treated plasma (SDP) over one cycle (nine days) of plasma exchange (PE) and subsequent procedures as required. Throughout treatment, ADAMTS 13 and protein S levels were followed. Results At the primary end point of one month, 3 of 35 of the CSP and 1 of 27 of the SDP patients died. The average platelet count was 184 × 109 per litre for CSP and 209 × 109 per litre for SDP. While vWF and FVIII were elevated in all patients at entry, no unusually large vWF multimers were seen at any time. At entry 9 patients had ≤ 0–10% ADAMTS 13 and 14 of 62 had normal levels with the rest in between. At presentation only 9 patients had 100% inhibitor activity with no inhibitor in 18 patients. Of the four patients who died, two who received CSP, had 100% enzyme activity at presentation whereas one had no ADAMTS-13 and another had 10%. All 4 patients died within 10 days. Fifteen patients with less than 10% enzyme activity had >1.5 vWF. However, elevated (>3u/mL) vWF was seen in the presence of normal ADAMTS-13 levels. Six months after remission, and in the presence of a normal platelet count, ADAMTS13 remained low in 5 patients and normal in 15.Protein S levels in 41/62 patients studied showed little variation during therapy with values on day 3 and 5, similar to those seen on entry. Conclusion In idiopathic TTP, ADAMTS 13 levels do not correlate with disease, and are not predictive of outcome. While protein S levels in the SDP were lower than those found in FFP, this did not appear to have clinical significance.


2009 ◽  
Vol 32 (4) ◽  
pp. 403-410 ◽  
Author(s):  
S. Cortelazzo ◽  
P. Viero ◽  
C. Casarotto ◽  
A. D'Emilio ◽  
E. Dini ◽  
...  

1979 ◽  
Author(s):  
J. G. Kelton ◽  
P. B. Neame ◽  
I. Walker ◽  
A. G. Turpie ◽  
J. McBride ◽  
...  

Thrombotic thrombocytopenic purpura (TTP) is a rare but serious illness of unknown etiology. Treatment by plasmapheresis has been reported to be effective but the mechanism for benefit is unknown. We have investigated the effect of plasmapheresis in 2 patients with TTP by quantitating platelet associated IgG (PAIgG) levels prior to and following plasmapheresis. Both patients had very high levels of PAIgG at presentation (90 and A8 fg IgG/platelet respectively, normal 0-5). in both, the PAIgG levels progressively fell to within the normal range and the platelet count rose following plasmapheresis. One patient remained in remission with normal platelet counts and PAIgG levels. The other relapsed after plasmapheresis and the PAIgG level rose prior to the fall in platelet count. Plasmapheresis was repeated and resulted in normalization of both the platelet count and PAIgG level. It is suggested that plasmapheresis removes antiplatelet antibody or immune complexes which may be of etiological importance in this illness.


Author(s):  
С.М. Маматов ◽  
А.К. Эсенгелди ◽  
А.А. Махмануров

Введение. Вопрос о дальнейшем совершенствовании базисной терапии идиопатической тромбоцитопенической пурпуры (ИТП) по-прежнему широко обсуждается специалистами и является предметом оживленных дискуссий. Цель исследования: изучить динамику геморрагического синдрома и количества тромбоцитов у детей с ИТП в процессе высокогорной климатотерапии и оценить эффективность воздействия высокогорной гипоксии на течение болезни. Материалы и методы. В исследование включено 24 ребенка с хронической ИТП в возрасте от 5 до 14 лет (средний возраст — 10,25 ± 1,43 года) с длительностью заболевания от 4 до 8 лет. Для лечения детей поднимали на высокогорную базу Туя-Ашу (перевал Туя-Ашу, 3200 м над уровнем моря). Продолжительность лечения в высокогорье составляла 40 дней. Результаты. К концу срока пребывания в горах значительно уменьшались проявления геморрагического синдрома, полностью купировался анемический синдром, количество тромбоцитов достоверно увеличивалось с минимума 22,1 × 109/л до максимума 108,4 × 109/л. Заключение. Из 22 детей, получивших высокогорную климатотерапию, у 2 детей достигнута полная и у 15 — частичная ремиссия. У 4 детей улучшение клинико-гематологических показателей носило временный характер, и отсутствие эффекта зарегистрировано у 1 ребенка. Ремиссия достигнута у 77% больных детей. Introduction. Further improvement of the basic therapy of idiopathic thrombocytopenic purpura (ITP) is still widely discussedby specialists and is the subject of lively discussions. Aim: to study the dynamics of hemorrhagic syndrome and platelet count in children with ITP in the process of high-altitude climatotherapy and assess the eff ectiveness of high-altitude hypoxia exposure on the course of the disease. Materials and methods. The study included 24 children with chronic ITP aged 5 to 14 years (mean age — 10.25 ± 1.43 years) with disease duration from 4 to 8 years. For treatment children were raised to Tuya-Ashu high-altitude base (mountain pass Tuya Ashu, 3200 m above sea level). The duration of treatment in highlands was 40 days. Results. By the end of the treatment, the manifestations of hemorrhagic syndrome decreased signifi cantly, the anemic syndrome completely stopped, the platelet count increased significantly from minimum of 22.1 × 109/L to maximum of 108.4 × 109/L. Conclusion. High-altitude climatotherapy received 22 children, 2 children had complete remission and 15 — part remission. In 4 children the improvement of clinical and hematological parameters was temporal, and the absence of eff ect was registered in 1 child. Remission was achieved in 77% of ill children.


1996 ◽  
Vol 2 (3) ◽  
pp. 213-218
Author(s):  
Nobuo Sakuragawa ◽  
Kojiro Yasunaga ◽  
Takeo Nomura ◽  
Junichi Akatsuka ◽  
Atsushi Kuramoto ◽  
...  

TJ-137 administered to patients with chronic ITP increased the platelet count "slightly" or more in 31.7% of the patients and showed a clinical effect in 40.9% with a rating of "modestly effective" or better. With a low incidence of adverse reactions, TJ-137 is ex pected to be a new drug for the treatment of ITP.


2018 ◽  
Vol 35 (6) ◽  
pp. 671-675 ◽  
Author(s):  
Emily Ankus ◽  
Sarah J Price ◽  
Obioha C Ukoumunne ◽  
William Hamilton ◽  
Sarah E R Bailey

Blood ◽  
1978 ◽  
Vol 51 (3) ◽  
pp. 479-486
Author(s):  
Z Zeigler ◽  
S Murphy ◽  
FH Gardner

Microscopic evaluation of apparent platelet size and morphology was examined in a variety of hematologic disorders. The time of preparation of the blood smear was important. An artifactual increase in platelet size was noted on blood films from 20 normal individuals that were prepared either immediately or 180 min after venipuncture. The clearest differentiation of patient categories was obtained with smears prepared 60 min after venipuncture using blood anticoagulated with K3EDTA. Under these conditions, normal size and morphology values were found in thrombocytopenic patients with aplasia or with increased splenic pooling. In contrast, large size values were a reliable finding in idiopathic thrombocytopenic purpura patients, whose platelet counts were less than 50,000/microleter. Large size values were also noted in patients with infiltrated bone marrows or myeloproliferative syndromes regardless of the platelet count. The last two groups usually showed abnormal platelet morphology with greater than 10% hypogranular platelets. Normal platelet size and morphology were observed in patients with iron-deficiency and megaloblastic anemias and in patients with idiopathic thrombocytopenic purpura and systemic lupus erythematosus who had normal platelet counts.


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