Aggressive combination therapy in the successful management of life-threatening intracranial hemorrhage in a patient with idiopathic thrombocytopenic purpura

The American Journal of Pediatric Hematology/oncology
W K HootsA Bracey

Abstract

We describe acute therapy for a 13-year-old female from Panama with chronic idiopathic thrombocytopenia purpura (ITP) refractory to steroids, splenectomy, vinca alkaloids, and azathioprine. She presented with neurologic deterioration from a posterior fossa intracranial hemorrhage (ICH). This followed a 3-month history of severe dysfunctional uterine bleeding, progressive from menarche, which had required multiple red cell transfusions. Steroid and vinblastine therapy and transfusion of 40 U of platelets failed to increase the platelet count above 10,000/microliter. Development of a second larger ICH (frontal) produced morbid increase in intracranial pressure that necessitated neurosurgical decompression. Plasma exchange and colloid repletion with intravenous gamma globulin (1 g/kg) and an infusion of 20 U of platelets resulted in a transient rise in platelet count to 160,000/microliter, permitting surgery without bleeding. Danazol (800 mg/day) and conjugated estrogen (Premarin 25 mg/day) were begun to control the uterine bleeding. Intensive plasma exchange and i.v. IgG infusions were continued daily for 24 days, then twice weekly for several weeks. Platelet-bound IgG decreased almost 500% over the first 10 days of therapy, and ...Continue Reading

Citations

Jun 1, 1996·Pediatric Clinics of North America·D Medeiros, G R Buchanan
Mar 1, 1994·Annals of Emergency Medicine·D Sadowitz, T E Terndrup
Jun 21, 2016·Journal of Clinical Apheresis
Oct 18, 2012·Journal of Pediatric Hematology/oncology·John A D'OrazioNina Farhoudi
Aug 7, 2003·Journal of Pediatric Hematology/oncology·Linda J Butros, James B Bussel

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