Abstract
We report on a case of idiopathic thrombocytopenic purpura (ITP). This patient showed a remarkable generalised bleeding tendency which was refractory to various therapies. Therapeutic plasmapheresis (TPP) was given to increase the platelet count and then splenectomy was performed, and the platelet count became normal.
The patient was a 23-year-old male presenting with gingival bleeding and general purpura without any predisposing causes. The platelet count was as low as 0.1×104/mm3 and remained unchanged despite the transfusion of 60 packs (20 packs/day×3 days) of platelet concentrate and the administration of hydrocortisone 500mg, prednisolone 60mg and methylprednisolone 1g. He was therefore admitted to the hospital.
On admission, the patient exhibited a remarkable bleeding tendency with slight nasal bleeding, gingival bleeding, hematuria, tarry stools and generalized diffuse petechiae and purpura. Antiplatelet antibody was negative, and platelet-associated immunoglobulin G (PA-IgG) was as high as 390.1ng/107 cells. Bone marrow aspiration showed an increase in megakaryocytes, leading to the diagnosis of ITP.
High-dose methylprednisolone therapy (starting at 1, 000mg/day followed by a gradual reduction) and highdose γ-globulin therapy (dried pH 4-treated human immunoglobulin 2.5g×20 vials, i. v.) improved the platelet count only to 1.2×104/mm3, and the bleeding tendency persisted. Endoxan 1, 000mg/day was then administered, but this produced no improvement in symptoms. TPP therapy was therefore undertaken. Since this tended to elevate the platelet count, TPP was performed for a total of six times. During the therapy, the platelet count increased to a peak of 10.4×104/mm3 but tended to decrease again. Splenectomy was performed when the platelet count was 6.1×104/mm3. The platelet count increased remarkably to 67.2×104/mm3 and remained normal thereafter so the patient was discharged.
