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Persistently Perplexing Purpuras: Thrombotic Thrombocytopenic Purpura and Immune Thrombocytopenic Purpura
- Richard S. Stein, MD; and
- John M. Flexner, MD
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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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
