LETTER
Persistently Perplexing Purpuras: Thrombotic Thrombocytopenic Purpura and Immune Thrombocytopenic Purpura
Richard S. Stein, MD, and
John M. Flexner, MD
1 November 1994 | Volume 121 Issue 9 | Pages 720-721
TO THE EDITOR:
We read with interest Olenich and Schattner's report [1] on postpartum thrombotic thrombocytopenic purpura (TTP) complicating immune thrombocytopenic purpura (ITP) of pregnancy and agree wholeheartedly with their emphasis on examining the peripheral smear in cases of thrombocytopenia. In a high-technology era, it is rewarding to see the value of a low-technology procedure. Although the authors asserted that coexistence of the two disorders had not been documented, we previously reported a series of three patients with TTP who developed immune thrombocytopenia while their TTP was in remission [2]. Patient 1 in our series initially presented with postpartum TTP before developing ITP. Since that report was published, we have observed an additional case of ITP that occurred after treatment of TTP and that responded to splenectomy. An additional case has been reported to us by a colleague at another institution. The association of TTP and ITP may not be that rare but clearly will not be noted if physicians fail to examine the peripheral smear.
1. Olenich M, Schattner E. Postpartum thrombotic thrombocytopenic purpura (TTP) complicating pregnancy-associated immune thrombocytopenic purpura (ITP). Ann Intern Med. 1994; 120:845-7.
2. Stein RS, Flexner JM. Idiopathic thrombocytopenic purpura during remission of thrombotic thrombocytopenic purpura. South Med J. 1984; 77:1599-601.
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