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Persistently Perplexing Purpuras: Thrombotic Thrombocytopenic Purpura and Immune Thrombocytopenic Purpura
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 Unpublished letters cannot be returned.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.
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.
Raphael B. Stricker, MD
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
