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  • Title: Thrombotic thrombocytopenic purpura: a ten-year experience.
    Author: Cuttner J.
    Journal: Blood; 1980 Aug; 56(2):302-6. PubMed ID: 6156729.
    Abstract:
    Splenectomy, corticosteroids, and antiplatelet agents have improved survival in thrombotic thrombocytopenic purpura (TTP). In 1974 we reported the successful treatment in 5 of 6 patients using splenectomy, corticosteroids, and average molecular weight dextran. This report describes a 10-yr experience with TTP at Mount Sinai Hospital (MSH). Twenty patients with TTP were seen. Possible inciting factors included pregnancy, oral contraceptives, and surgery. Splenectomy was performed in 18 patients and typical findings of TTP were found in 14 (78%). Fifteen patients were treated with splenectomy, corticosteroids, and average molecular weight dextran. Two of the 15 patients received, in addition, ASA and dipyridamole and a third received only dipyridamole. Thirteen of the 15 (87%) have survived and remain disease-free. 20 patients with thrombotic thrombocytopenic purpura (TTP) admitted to the Mt. Sinai Hospital for the l0-year period 1969 through 1979 were followed up. TTP is a highly fatal disease with a mortality rate of 77%. The most effective treatments for TTP are splenectomy, corticosteroids, and antiplatelet agents. Possible etiologic factors are pregnancy, oral contraceptives and surgery. Splenectomy was performed in 18 patients, 7 of whom died. 14 of the 18 (78%) had intravascular thrombi in arterioles and capillaries. 15 patients were managed with splenectomy, corticosteroids, and average molecular weight dextran. 13 of the 15 (87%) have remained disease-free since. Corticosteroids should be initially given as hydrocortisone 800-1000 mg/day for 1 week and then decreased slowly over the next week. Prednisone and dextran should subsequently be given and if the patient does not respond, other antiplatelet agents, especially dipyridamole should be added. Plasmapheresis should be carried out if there is still no response.
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