LETTER
Persistently Perplexing Purpuras: Thrombotic Thrombocytopenic Purpura and Immune Thrombocytopenic Purpura
Raphael B. Stricker, MD
1 November 1994 | Volume 121 Issue 9 | Pages 720-721
TO THE EDITOR:
Olenich and Schattner [1] report a case of postpartum TTP complicating pregnancy-associated ITP. The authors state that "the coexistence of these two disorders has not been previously reported in the English-language literature."
Although coexistent TTP and ITP may not have been reported during pregnancy, the association between these two diseases has previously been described in various settings. Elevated levels of platelet-associated antibodies have been noted in patients with TTP [2, 3], and the sequential development of TTP and ITP has been described in several cases, including one after pregnancy [4]. Further, the association between TTP and ITP in patients infected with the human immunodeficiency virus has recently been recognized [5], as predicted by the authors. Thus, TTP and ITP may coexist in the susceptible host, and the role of immunologic factors in TTP remains an enigma.
Olenich and Schattner make the important point that the diagnosis of TTP may be overlooked if pertinent data are not carefully evaluated. Perhaps another lesson is that, given the vicissitudes of searching the medical database, caution should be exercised when making statements about the "English-language literature" because pertinent articles may be overlooked.
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. Bodensteiner D, Rosenfeld C. Elevated platelet-surface-bound IgM in thrombotic thrombocytopenic purpura. South Med J. 1988; 81:81-3.
3. Stricker RB, Davis JA, Gershow J, Yamamoto K, Kiprov DD. Thrombotic thrombocytopenic purpura complicating systemic lupus erythematosus: report of a case and review of the literature from the plasmapheresis era. J Rheumatol. 1992; 19:1469-73.
4. Stein RS, Flexner JM. Idiopathic thrombocytopenic purpura during remission of thrombotic thrombocytopenic purpura. South Med J. 1984; 77:1599-601.
5. Routy JP, Beaulieu R, Monte M, Saint-Louis J, Sauvageau G, Toma E. Immunologic thrombocytopenia followed by thrombotic thrombocytopenic purpura in two HIV1 patients. Am J Hematol. 1991; 38:327-8.
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