LETTER
Persistently Perplexing Purpuras: Thrombotic Thrombocytopenic Purpura and Immune Thrombocytopenic Purpura
Dorothea Zucker-Franklin, MD
1 November 1994 | Volume 121 Issue 9 | Pages 720-721
TO THE EDITOR:
The recent report by Olenich and Schattner [1] of a case considered to represent postpartum TTP did not provide sufficient data to permit this diagnosis. Of the usual manifestations of TTP—thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, fever, and renal dysfunction—the patient in question seemed to have only two. Apparently, no hypertension, neurologic symptoms, or evidence of consumption coagulopathy were noted. A description of a skin or mucosal biopsy specimen confirming the clinical impression by showing aneurysmal dilatation at arteriocapillary junctions and hyaline deposits was also absent [2]. Unquestionably, this patient had thrombocytopenia and hemolytic anemia. We previously showed that nearly all patients with chronic ITP have subclinical erythrocyte fragmentation [3]. When hemolysis becomes clinically significant, as in Olenich and Schattner's patient, it is usually referred to as the Evan syndrome [4]. Despite some improvement in the management of TTP, the prognosis of the syndrome remains much more grave than that of acute or chronic ITP, with or without overt hemolysis.
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. Kwaan HC. Clinicopathologic features of thrombotic thrombocytopenic purpura. Semin Hematol. 1987; 24:71-81.
3. Zucker-Franklin D, Karpatkin S. Red-cell and platelet fragmentation in idiopathic autoimmune thrombocytopenic purpura. N Engl J Med. 1977; 297:517-23.
4. Evans RS, Takahashi K, Duane AB, Payne R, Liu CK. Primary thrombocytopenic purpura and acquired hemolytic anemia: evidence for a common etiology. Arch Intern Med. 1951; 87:48-65.
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