Acute Severe Thrombocytopenia Research Articles

Immune thrombocytopenia: Surgical therapy and predictors of response

We have reviewed 40 patients with immune thrombocytopenia purpura (ITP) to assess current methods of preparation for surgery and to evaluate perioperative complications and response to splenectomy. Twenty-one patients had chronic ITP (greater than 1 year duration) and 19 patients had severe acute thrombocytopenia (platelet counts less than 10,000). A progression of methods of pretreatment was seen in the 10-year period reviewed. Seventeen patients received no treatment before admission for surgery, and 10 of these received platelet transfusions. Seventeen patients received steroids immediately preceding surgery; 16 of these responded and 1 received a platelet transfusion. Recently, 5 patients received intravenous gamma globulin (IgG) preceding surgery with all patients responding and none receiving platelet transfusions. One patient received a combination of steroids and IgG with good response and did not require platelet transfusion. No major postoperative complications occurred (ie, pancreatitis, small bowel obstruction, or sepsis) except for one patient requiring a secondary exploration for an accessory spleen and recurrent thrombocytopenia. Eight patients (20%), 6 with severe ITP and 2 with chronic ITP (5 males and 3 females) developed recurrence of thrombocytopenia following surgery up to 1 1/2 years after splenectomy. These patients all required further medical therapy. Three additional patients (2 chronic and 1 severe) developed thrombocytopenia following viral illnesses, but required no further therapy. Of the 8 surgical failures, 4 failed to respond to prior treatment with steroids, 1 to IgG, and 2 failed to respond to combination therapy, while one surgical failure responded to both steroid and combination therapy. Of the responders to splenectomy (32 patients), only 3 failed to respond to prior treatment with steroids.(ABSTRACT TRUNCATED AT 250 WORDS)

Infectious mononucleosis with acute thrombocytopenia

Three cases of severe acute thrombocytopenia complicating infectious mononucleosis are described. Although spontaneous remission may be a feature of this rare complication, in each of these cases steroid therapy resulted in a rapid rise in the platelet count.

Idiopathic thrombocytopenic purpura in adults.

Idiopathic thrombocytopenic purpura (ITP) is a primary immune thrombocytopenia that is typically manifested in adults by acute bleeding, severe thrombocytopenia, and normal to increased megakaryocytes in the bone marrow. Labeling studies suggest that most patients with ITP have an IgG antibody directed against the platelet membrane resulting in sequestration in the spleen, and that sequestration in other organs such as the liver bodes a poor prognosis. Splenectomy and/or corticosteroids remain the mainstay of therapy, with permanent remissions induced in 75% of patients. We review alternative forms of therapy such as immunosuppressive agents, high-dose gamma-globulin, and others to enable the practicing physician to select the best treatment for patients refractory to standard therapy. Age appears to influence response to therapy and morbidity, with advancing age imparting a poorer prognosis.

Acute Hepatitis Presenting Severe Thrombocytopenia with Phagocytosis of Platelets by Macrophages in the Bone Marrow

Acute Hepatitis Presenting Severe Thrombocytopenia with Phagocytosis of Platelets by Macrophages in the Bone Marrow

Chlorpheniramine-Dependent Thrombocytopenia

SEVERE thrombocytopenia, as a consequence of an immune reaction, is a rare complication of therapy with a wide variety of drugs.1With respect to the antihistamines, antibody-mediated thrombocytopenia has been demonstrated in only a single case in which antazoline hydrochloride was implicated.2We report a case of chlorpheniramine-induced thrombocytopenic purpura in which serologic study established the presence of a drug-dependent IgG antiplatelet antibody. The patient's serum displayed antiplatelet activity in the presence of the closely related compound, brompheniramine maleate, but did not react with other antihistamines. Report of a Case A 53-year-old man was hospitalized on Sept 20, 1973, with generalized petechiae, hematuria, and melena. In the spring and summer of 1951 he had been hospitalized three times for severe acute thrombocytopenia. Each episode had followed an upper respiratory tract infection, and complete recovery had occurred spontaneously within two weeks. In August 1951 he underwent splenectomy, despite a