Abstract
In this report, the authors have investigated the presence of a humoral factor inducing the condition of idiopathic thrombocytopenic purpura and have obtained the following results:
1) The serum and the urine of the thrombocytopenic purpura patient produce an anemia in rabbits experimentally. This anemia-producing factor in the serum is soluble in water, but insoluble in ether and ethanol, and that in the urine is precipitated by methanol.
2) The serum of the patient also shows an action reducing the platelets of rabbits. The platelet-reducing factor is not identical with the anemia-producing factor, as the former is not demonstrated in the urine extract.
Summarizing the first and the second reports, the conclusion is drawn as follows:
1) Three cases of idiopathic thrombocytopenic purpura were reported. Among subjective and objective findings, specific hemorrhagic tendency, Fragility of the capillaries, splenic pancytopenia and relative decrease of mature megakaryocytes in the bone-marrow were pathognomonic.
2) The objective findings accounted for the so-called “hypersplenism”, except for splenomegaly which did not exceed one fingerbreadth below the costal margin in all cases.
3) Splenectomy should have been indicated to two fatal cases, as the conservative therapy had poor results.
4) The theory of “hypersplenism” for the pathogenesis of this condition should be modified from the humoral point of view, since these demonstrated factors are most probably associated with the spleen.
5) The anemia occurring in the later stage, which has been attributed to the loss of the blood, could, in some instances, be primary and splenic in its origin.
