抄録
Refractory idiopathic thrombocytopenic purpura (refractory ITP) is defined as ITP of greater than 7 months' duration and which failed to respond to both corticosteroids and splenectomy. Among 19 cases, 2 were refractory ITP. One case was 32-year-old male with ecchymoses and gum bleeding. Platelet count was 8,000/mm3. He had been treated with prednisolone and azathioprine, then splenectomized. These treatments revealed no effect and now he is followed in our out-patient clinic. Another case was 63-year-old male with tarry stool, ecchymoses, petechiae and anemia. Prednisolone was administered and splenectomy was performed. After that, azathioprine, then vincristine was administered. Although tarry stool stopped, the effect was not satisfactory.
In refractory ITP, it can be suggested that liver as well as spleen contributes significantly as a site of production of anti-platelet antibody and the sequestration of affected platelets. We discussed the immunosuppressants for the treatment of refractory ITP, reviewing previously reported cases.
