1988 Volume 11 Issue 3 Pages 309-314
A 75-year-old female was admitted to the Hospital of Yamanashi Medical School on April 22, 1985, because of rheumatoid arthritis (RA) and hemorrhagic diathesis.
Laboratory examinations, on admission, revealed an acceleration of erythrocyte sedimentation rate (124 mm/hr), positive RA test and thrombocyte count of 5×104/μl. The white blood cell count and the red blood cell count were within normal range. Examination of bone marrow disclosed no decrease of megakaryocyte counts. Shortened life span of thrombocytes, increased uptake of 51Cr-labeled thrombocytes in spleen and elevated levels of platelet-as-sociated IgG (PAIgG) were compatible with autoimmune thrombocytopenia. Treatments with large doses of γ-globulin or steroid hormone failed to restore her thrombocyte count. It decreased progressively to 1×104/μl within one year and platelet transfusions were occasionally required. She died of sepsis from suppurative arthritis on July 17, 1986.
In contrast to the frequent association of RA with thrombocytosis, RA is rarely associated with thrombocytopenia. Recently, with the measurement of PAIgG, autoimmune thrombocytopenia in patient with RA has been reported. Although thrombocytopenia in this case appears to be compatible with such an autoimmune mechanism, no case with such a severe thrombocytopenia and hemorrhagic diathesis has been reported.
