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World Journal of Gastroenterology 2017年第35期23卷 6540-6545页

作者： Shojiro Ichimata Mikiko Kobayashi Kohei Honda Soichiro Shibata Akihiro Matsumoto Hiroyuki Kanno Department of Pathology Shinshu University School of Medicine Department of Medicine Shinshu University School of Medicine

We report the first case of a patient with hepatitis C virus(HCV) infection and idiopathic thrombocytopenic purpura(ITP), who later developed acquired amegakaryocytic thrombocytopenia(AAMT), with autoantibodies to the thrombopoietin(TPO) receptor(c-Mpl). A 64-year-old woman, with chronic hepatitis C, developed severe thrombocytopenia and was diagnosed with ITP. She died of liver failure. Autopsy revealed cirrhosis and liver carcinoma. In the bone marrow, a marked reduction in the number of megakaryocytes was observed, while other cell lineages were preserved. Therefore, she was diagnosed with AAMT. Additionally, autoantibodies to c-Mpl were detected in her serum. Autoantibodies to c-Mpl are one of the causes of AAMT, acting through inhibition of TPO function, megakaryocytic maturation, and platelet formation. HCV infection induces several autoantibodies. HCV infection might also induce autoantibodies to c-Mpl, resulting in the development of AAMT. This mechanism may be one of the causes of thrombocytopenia in patients with HCV infection.

关键词： Hepatitis C virus Acquired amegakaryocytic thrombocytopenia Anti-thrombopoietin receptor(c-Mpl) autoantibodies Idiopathic thrombocytopenic purpura Thrombocytopenia

Low ADAMTS-13 in plavix induced thrombotic thrombocytopenic purpura

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World Journal of Clinical Cases 2013年第1期1卷 31-33页

作者： Long Bao Cao Christopher Jones Assad Movahed Department of Cardiovascular Sciences Brody School of MedicineEast Carolina University Greenville NC 27834 United States

Thrombotic thrombocytopenia purpura(TTP) was fi rst described in 1924 as a "pathologic alteration of the microvasculature, with detachment or swelling of the endothelium, amorphous material in the sub-endothelial space, and luminal platelet aggregation leading to compromise of the microcirculation". Ticlopidine induced TTP has been highly associated with autoimmune induced reduction in ADAMTS-13 activity. These findings, to a lesser extent, have also been found in clopidogrel induced TTP. We report a case of clopidogrel associated TTP in a patient that presented with acute stroke, renal failure, and non-ST elevation myocardial infarction.

关键词： Plavix Thrombotic thrombocytopenic purpura Antiplatelet therapy

Co-infection of Pneumocystis jirovecii and Aspergillus in a patient with idiopathic thrombocytopenic purpura

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Chinese Medical Journal 2019年第15期132卷 1881-1882页

作者： Dong-Hwa Lee Jun Yeun Cho Sun-Hyung Kim Hee-Sung Kim Ok-Jun Lee Yoon Mi Shin Department of Internal Medicine Chungbuk National University Hospital Chungbuk National University College of Medicine Cheongju 28644 Republic of Korea Department of Pathology Chungbuk National University Hospital Chungbuk National University College of Medicine Cheongju 28644 Republic of Korea

PCP and IA co-infection in HIV patients has been reported.[3] However,only nine cases co-infected with PCP and IA in non-HIV patients are reported.[4-6] Herein,we report a fatal case of PCP and IA co-infection in a pa... 详细信息

关键词： idiopathic thrombocytopenic purpura Pneumocystis jirovecii Aspergillus

Cardiac implications of thrombotic thrombocytopenic purpura

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World Journal of Cardiology 2018年第12期10卷 254-266页

作者： Szymon L Wiernek Bo Jiang Gregory M Gustafson Xuming Dai Division of Cardiology McAllister Heart Institute University of North Carolina at Chapel Hill Division of Cardiology Lang Research Center New York Presbyterian Medical Group–Queens Hospital

Thrombotic thrombocytopenic purpura(TTP) is a multisystem disorder that essentially can affect any organ in the human body. The hallmark of the pathogenesis in TTP is the large von Willebrand factor multimers on plateletmediated micro-thrombi formation, leading to microvascular *** studies showed that cardiac arrest and myocardial infarction are the most common immediate causes of death in these patients. Clinical manifestations of cardiac involvement in TTP vary dramatically, from asymptomatic elevation of cardiac biomarkers, to heart failure, MI and sudden cardiac death. There is limited knowledge about optimal cardiac evaluation and management in patients with TTP. The absence of typical cardiac symptoms,combined with complicated multi-organ involvement in TTP, may contribute to the under-utilization of cardiac evaluation and treatment. Prompt diagnosis and timely initiation of effective therapy could be critically important in selected cases. Based on our experience and this review of the literature, we developed several recommendations for focused cardiac evaluation for patients with acute TTP:(1) patients with suspected or confirmed TTP should be screened for the potential presence of cardiac involvement with detailed history and physical,electrocardiogram and cardiac enzymes;(2) clinical deterioration of TTP patients warrants immediate cardiac reevaluation;(3) TTP patients with clinical evidence of cardiac involvement should be monitored for telemetry, cardiac biomarkers and evaluated with transthoracic echocardiography. These patients require urgent targeted TTP treatment as well as cardiac-specific treatment. Aspirin therapy is indicated for all TTP patients. Since epicardial coronary artery involvement is rare, cardiac catheterization is usually not required, given the high risk for hemorrhage and kidney injury;(4) we recommend evidence-based medical therapy for ischemic symptoms and heart failure. TTP patients with evidence of cardiac invol

关键词： Thrombotic thrombocytopenic purpura Acute myocardial infarction Coronary artery disease Anti-platelet therapy von Willebrand factor ADAMTS13

Thrombotic thrombocytopenic Purpura in a Parturient Leading to Life-Threatening Thrombocytopenia and Neonatal Demise—A Case Report

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Maternal-Fetal Medicine 2023年第2期5卷 119-122页

作者： Amnon A.Berger John J.Kowalczyk Philip E.Hess Yunping Li Department of Anesthesia Critical Care and Pain MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215USA

Thrombocytopenia is common (up to 12%) in pregnancy;thrombotic thrombocytopenia is a rare cause of thrombocytopenia;however,it is immediately life-threatening to both mother and fetus and requires immediate *** is compounded by the need to act on a presumptive diagnosis with high level of suspicion given the relatively long laboratory confirmation time.A 31-year-old gravida 3,para 1 parturient at 26 weeks of gestation presented to outside hospital with recent onset of easy bruising and blurry vision.A blood count was drawn and showed a platelet count of 19,000/μ*** was transferred to our institution for management where an initial diagnosis of preeclampsia with severe features was made based on thrombocytopenia and fetal growth restriction (thrombocytopenic purpura and cesarean delivery was deferred after discussion with the patient and *** exchange and steroid therapy were started promptly,and her platelet count improved within 12 ***,the patient experienced neonatal *** ADAMTS13 levels confirmed diagnosis of thrombotic *** was transitioned to rituximab,platelets recovered to baseline,and she continues to do *** thrombocytopenia is a rare,life-threatening cause of thrombocytopenia in *** grim fetal prognosis,especially in early pregnancy,low threshold of suspicion,early anesthesia involvement,and multi-disciplinary approach can facilitate diagnosis and timely *** our case,it was likely lifesaving.

关键词： Thrombocytopenia Pregnancy Plasma exchange Preeclampsia Fetal death von Willebrand factor Purpura thrombocytopenic idiopathic HELLP syndrome.

Eltrombopag Managed Severe Immune thrombocytopenic Purpura in Pregnancy: A Case Report, Latifa Hospital, DHA, Dubai, UAE

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Open Journal of Obstetrics and Gynecology 2019年第7期9卷 991-996页

作者： Komal Sundeep Hazari Atif Bashir E. Fazari Taghrid Gergawi Hasan Mohamed A. Aal-Yaseen Nighat Aftab Department of Obstetrics & Gynecology Latifa Hospital DHA Dubai UAE Faculty of Medicine University of Medical Sciences & Technology Khartoum Sudan Department of Medicine Clinical Haematology Dubai Hospital DHA Dubai UAE

Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder, defined by a platelet count of less than 100 × 109/L, secondary to impaired production and immune destruction of platelets. Bleeding tendency is the main presentation of this condition. Clinical symptoms and investigations will confirm the diagnosis. Steroid is the first line of treatment. Although Rituximab and Thrombopoietin receptor agonists are useful second line agents in non-pregnant adults, the data about their role in pregnancy are still limited. We present the case of a 30 year old primigravida, who was a known case of chronic ITP since childhood;the course of her disease was fluctuating, for which oral steroids were used accordingly. She presented with gum bleeding and petechial rash with very low platelets count. She was sponsored by the Patient Support Program and was given Eltrombopag during the third trimester. She responded well to Eltrombopag with no noticeable side effects, neither to the mother nor to the baby so far. Eltrombopag has been assigned Category C by the Federal Drugs Agency (FDA) nevertheless there are no well controlled data in the literature about its role in pregnancy.

关键词： Immune thrombocytopenic Purpura Eltrombopag Pregnancy

Chronic Immune thrombocytopenic Purpura in a Young Female with Rheumatoid Arthritis (Unusual Course)

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Case Reports in Clinical Medicine 2018年第11期7卷 557-566页

作者： Sara Elhadari Asif Hashmi Hani Hussein Department of Medicine Armed Forces Hospital Jubail Saudi Arabia Department of Family Medicine Armed Forces Hospital Jubail Saudi Arabia

We present a case of a 29-year-old female from Sudan, who was diagnosed with rheumatoid arthritis (RA) in 2005 and with immune thrombocytopenic purpura (ITP) in 2009. The ITP immediately followed using, for four weeks, a combination of medications that included rifampicin. The platelets count continued to be low thereafter. During the year following her diagnosis with ITP, she reported gradual improvement in her joints symptoms, which continued during her pregnancy in 2011. Following puerperium, her chronic ITP resolved completely;however, her joint disease flared up few months later. To our knowledge, there are no reported cases of chronic ITP, which were drug induced at first in a patient of RA except with gold therapy. Similarly, there are no reports on cases that recovered from chronic ITP after delivery. Finally, this case highlights the impact different coexisting autoimmune diseases may have on each other regarding course and prognosis.

关键词： ITP Immune thrombocytopenic Purpura Drug-Induced Thrombocytopenia DITP Pregnancy Rheumatoid Arthritis

Lymphocytosis in Idiopathic thrombocytopenic Purpura Patients Infected by <i>Helicobacter pylori</i>

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Open Journal of Blood Diseases 2013年第1期3卷 32-35页

作者： Naoki Takezako Naohiro Sekiguchi Akira Tanimura Chiho Homma Tateki Shikai Yayoi Takezako Noboru Yamagata Akiyoshi Miwa Department of Hematology National Center for Global Health and Medicine Tokyo Japan. Department of Hematology National Hospital Organization Disaster Medical Center of Japan Tokyo Japan

Background and Objectives: Several recent reports have demonstrated a close linkage between idiopathic thrombocytopenic purpura (ITP) and Helicobacter pylori (H. pylori) infection in some patient’s populations. However, the pathogenetic mechanisms of H. pylori-induced thrombocytopenia remain obscure. Therefore, we investigated the prevalence of H. pylori infection pylori and performed a comparative analysis of a subset of H. pylori-infected patients (group A) with non-infected patients (group B) using the standard statistical methods. Design and Methods: From December 2001 to October 2002, we investigated the presence of gastric H. pylori infection in 30 adult ITP patients and 19 patients were treated with standard antibiotic therapy for H. pylori eradication (amoxicillin and clarithromycin plus lansoprazole combination). We used the standard statisticsto analyze the difference between group A and group B. Results: H. pylori eradication was achieved in 17/19 (89.4%) ***-infected patients. An improvement of platelet count was observed in 14/19 patients (73.6%) who achieved the eradication. Five of these patients achieved CR (two patients were with the acute ITP) and nine patients reached PR. The difference between the mean platelet count ± S.D. before and after H. pylori therapy was statistically significant in patients with successful decontamination (65 ± 48 × 109/L vs. 200 ± 140 × 109/L;p = 0.018). Lymphocyte counts at the diagnosis of H. pylori infected cases were significant higher than those of non-infected cases (1.58 ± 0.13 ×

关键词： Idiopathic thrombocytopenic Purpura Helicobacter pylori Eradication Lymphocytosis Helper Th1 Lymphocyte

A case of adverse reactions of immune thrombocytopenic purpura caused by poliovirus vaccine

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Discussion of Clinical Cases 2018年第1期5卷 27-29页

作者： Sumei Li Yuping Zhao Department of Pharmacy The Third Affiliated Hospital of Inner Mongolia Medical UniversityBaotouInner MongoliaChina

The child patient, male, 4 months and 16 days old, was vaccinated orally by Type I Type III Live Attenuated Oral Poliomyelitis Vaccine (human diploid cells) at 10:45 a.m. on June 1st of 2016 in Shaoxian Community Health Service Center of our hospital. Two hours after vaccination, the child patient showed erythema scattered on the upper of the left knee, on the right calf and on the abdomen. The forearm of the left upper limb was scattered with punctate rashes. He was admitted to Department of Pediatrics of our hospital at 12:32 on June 1st of 2016. The diagnosis was 'immune thrombocytopenic purpura'. After admission, the child patient received expert consultation and systematic treatment, consequently getting better.

关键词： Poliovirus vaccine thrombocytopenic purpura Adverse drug reaction

Gastrointestinal infection-related disseminated intravascular coagulation mimicking Shiga toxin-mediated hemolytic uremic syndrome-implications of classical clinical indexes in making the diagnosis:A case report and literature review

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World Journal of Clinical Cases 2019年第13期7卷 1660-1670页

作者： Xiang-Yang Li Yan-Fen Mai Jing Huang Pearl Pai Department of Nephrology The University of Hong Kong-Shenzhen Hospital Shenzhen 518053 Guangdong Province China Department of Hematology The University of Hong Kong-Shenzhen Hospital Shenzhen 518053 Guangdong Province China Department of Medicine The University of Hong Kong - Queen Mary Hospital Hong Kong China

BACKGROUND Thrombocytopenia associated with acute kidney injury is a challenging disorder. Thrombotic microangiopathy (TMA) is a potentially life- or organ-threatening syndrome that can be induced by several disorders or medical interventions. There is overlap between the clinical presentation and pathophysiology of thrombotic thrombocytopenia purpura and hemolytic uremic syndrome (HUS), and to a lesser extent, disseminated intravascular coagulation (DIC). We describe a case to illustrate the potential diagnostic difficulty, especially at initial presentation. CASE SUMMARY We reported a case of a 44-year-old woman that presented with diarrhea, thrombocytopenia, schistocytes, elevated serum lactate dehydrogenase (LDH) level and acute kidney injury. While the clinical presentation resembled that of Shiga toxin–induced HUS, the disease course was more consistent with gastrointestinal infection-related DIC. To aid in the accurate diagnosis of TMA and other associated disorders, we have undertaken a review and provided a clear interpretation of some typical biomarkers including schistocytes, LDH and platelet count, coagulation profile and more specific indexes of ADAMTS13, complement profile, and the isolation of Shiga toxin-producing Escherichia coli (commonly referred to as STEC). CONCLUSION The use and correct interpretation of classical indexes of schistocyte, LDH, and platelet count is vital in diagnosing TMA and associated disorders. Understanding the characteristics of these biomarkers in the context of thrombocytopenia purpura, HUS and DIC will facilitate the accurate diagnosis and early initiation of appropriate treatment.

关键词： Thrombotic microangiopathy Thrombotic thrombocytopenic purpura Hemolytic uremic syndrome Schistocyte Lactate dehydrogenase Thrombocytopenia Case report