11/421. Two cases of autoimmune thrombocytopenic purpura associated with antiphospholipid antibodies. We report 2 cases of autoimmune thrombocytopenic purpura associated with antiphospholipid antibodies. In the first case the titer of antiphospholipid antibodies was neither related to disease activity nor influenced by immunosuppressive therapy. In the second, cerebral infarction occurred in spite of severe thrombocytopenia. Our results provide additional evidence that antiphospholipid antibodies are not involved in the pathogenesis of autoimmune thrombocytopenic purpura. Nevertheless, the frequency and clinical significance of this association would suggest that patients with autoimmune thrombocytopenic purpura should be tested for antiphospholipid antibodies, particularly before pregnancy or surgical procedures. ( info) |
12/421. Massive intracranial bleeding requiring emergency splenectomy in a patient with CMV-associated thrombocytopenia. We describe a previously healthy male patient, with severe immune thrombocytopenic purpura (ITP) following CMV infection which was refractory to steroids and intravenous immunoglobulin, who developed massive intracranial bleeding. Despite an extremely low platelet count (2x10(9)/liter) which was refractory to platelet transfusions, successful emergency splenectomy was performed, with rapid resolution of the thrombocytopenia. Bleeding complications are extremely rare in viral-associated ITP. Emergency splenectomy should be considered in the presence of life-threatening bleeding when other modalities fail to produce a rise in the platelet count. infection with CMV should be ruled out in cases of severe, treatment-resistant ITP. ( info) |
13/421. Localization of small bowel bleeding by arterial injection of Tc-99m-labeled RBC. A 79-year-old man with melena was suspected of having small bowel bleeding because upper and lower endoscopic findings were negative. technetium-99m-labeled red blood cell (Tc-99m-RBC) scintigraphy was performed by arterial injection of a radiotracer from the superior mesenteric artery (SMA) after angiography. Extravasation was seen in the ileum by scintigraphy although angiography was negative. Scintigram 2 minutes after arterial injection was consistent with the late capillary phase of balloon occluded angiography. This comparison provided a better anatomical distinction. Tc-99m-RBC scintigraphy by arterial injection through the SMA identified the bleeding site in the small bowel more accurately than conventional intravenous Tc-99m-RBC scintigraphy. ( info) |
14/421. Idiopathic thrombocytopenic purpura associated with breast cancer: a case report and review of the current literature. The association of solid tumors with idiopathic thrombocytopenic purpura (ITP) is rare. Before this study, there have been three case reports indicating an association between breast cancer and ITP. We present a 69-year-old man with metastatic breast cancer and progressive thrombocytopenia without any evidence of a leukoerythroblastic picture or etiologies for the thrombocytopenia. serum platelet antibodies were identified. A bone marrow biopsy showed small foci of metastatic breast cancer, thrombocytopenia, and normal number of megakaryocytes. A subsequent trial of steroids resulted in a marked improvement of the patient's thrombocytopenia. This is the fourth case report indicating an association of breast cancer and ITP. ( info) |
| An 8-month-old male with X-linked lymphoproliferative disease underwent an unrelated, partially matched (with major mismatch at DR locus), cord blood stem cell transplant. Four months following the transplant, he developed immune thrombocytopenia with hemolytic anemia (Evans syndrome). He received multiple courses of intravenous immunoglobulin, anti-Rh D immunoglobulin, a pulse of high-dose corticosteroids and cyclosporine with some improvement of hemolytic anemia, but no improvement of the thrombocytopenia. Addition of vincristine, resulted in long-term resolution of thrombocytopenia and anemia. No major toxicity was observed during treatment. vincristine should be considered as a treatment for refractory immune thrombocytopenia after hematopoietic stem cell transplantation. ( info) |
16/421. Autoimmune thrombocytopenia in a patient with small cell lung cancer developing after chemotherapy and resolving following autologous peripheral blood stem cell transplantation. A 46-year-old white male with small cell lung cancer (SCLC) limited to the thorax developed autoimmune thrombocytopenic purpura (AITP), following a cyclophosphamide, paclitaxel and G-CSF-containing regimen for peripheral blood stem cell (PBSC) mobilization. AITP associated with small or non-small cell lung cancer has been reported. We considered that the AITP in this case may be a part of paraneoplastic syndrome, which is frequently seen in patients with SCLC. The patient received HDC and autologous PBSC transplantation (APBSCT) for SCLC and the AITP resolved following transplantation, thus supporting the concept of HDC APBSCT for the treatment of autoimmune diseases. ( info) |
17/421. Partial splenectomy in a child with human immunodeficiency virus-related immune thrombocytopenia. Immune thrombocytopenia (IT) is a frequently occurring disease in childhood and a well known complication of HIV infection. splenectomy is a part of the treatment strategy for severe chronic IT. However, overwhelming infections after splenectomy have limited its use, especially in young children. A 7-year-old child with maternal-fetal hiv-1 infection and related thrombocytopenia underwent splenectomy after previous treatment failed to improve her platelet count. Approximately 75% of the spleen was removed. The postoperative period was uncomplicated, and the platelet count increased significantly to greater than 500,000/mm3. Ultrasonographic examination performed 3 months later showed a stable volume of the spleen stump (40 x 40 x 20 mm) with effective "vascularization." The platelet count 12 months after surgery showed a sustained increase greater than 150,000 cell/mm3. Subtotal splenectomy may be a safe and effective alternative for patients with HIV and immune thrombocytopenia. ( info) |
18/421. Ulcerative colitis and immune thrombocytopenia: a report of two cases. Ulcerative colitis is known to be associated with autoimmune diseases. We report two patients with coexistent ulcerative colitis and immune thrombocytopenia, a rare association. ( info) |
19/421. Redo cardiac surgery for atrial septal defect in a patient with idiopathic thrombocytopenic purpura. Preoperative management with high-dose intravenous gamma-globulin. A 58-year-old woman with idiopathic thrombocytopenic purpura required redo cardiac surgery of atrial septal defect closure, mitral annuloplasty, and tricuspid annuloplasty. Preoperative high-dose intravenous gamma-globulin and platelet transfusion after termination of cardiopulmonary bypass allowed successful redo cardiac surgery. Management of a patient with idiopathic thrombocytopenic purpura undergoing open heart surgery are discussed. ( info) |
20/421. Leukocytoclastic vasculitis following staphylococcal protein a column immunoadsorption therapy for idiopathic thrombocytopenic purpura. A patient with refractory idiopathic thrombocytopenic purpura developed widespread palpable purpura, fever, diarrhea, and arthralgias forty-eight hours following a third protein A immunoadsorption treatment. A skin biopsy revealed leukocytoclastic vasculitis. His skin lesions and constitutional symptoms resolved with administration of antibiotics and bed rest. ( info) |