Thrombotic thrombocytopenic purpura concomitant with autoimmune thyroiditis

Abstract

Thrombotic thrombocytopenic purpura (TTP) is charac­terized by disseminated thrombotic occlusions located in the microcirculation, microangiopathic hemolytic anemia, thrombocytopenia, fever, and renal and neurologic abnor­malities. A 14 year old girl admitted to our hospital com­plaining bruising on her body and prolonged menstrual bleeding. On her physical examination there were very common bruising on four extremities. On the laboratory studies, Hemoglobin was 9 g/dL; Hematocrit, 24%; white blood count 11600/mm3 and thrombocyte count, 9.000/mm3. According to these findings our first diagnose was idiopatic thrombocytopenic purpura so intravenous im­munoglobulin was given to patient for two days. Bone marrow aspiration was performed because of persisting thrombocytopenia despite two days IVIG therapy. In­creased number of megakaryocytes was seen in bone marrow. Some accompanying symptoms like headache, numbness in per oral region and extremities, difficulty in speaking, and fluctuation in consciousness for short time occurred. The patient was reevaluated; because throm­bocytopenia persisted and some neurological symptoms was observed. Due to these findings we thought that TTP was the diagnosed and plasma exchange was started. Increase was seen in platelet count in the second days of treatment. TTP should be considered in children present­ing with atypical thrombocytopenia.

Keywords

• Thrombotic thrombocytopenic purpura, auto­immune thyroiditis, thrombocytopenia, adolescent

Trombotik trombositopenik purpura ile eş zamanlı otoimmün tiroidit

Abstract

Trombotik trombositopenik purpura (TTP); mikrosirku­lasyonda localize yaygın trombotik tıkanıklıklar, mikroan­giopatik hemolitik anemi, trombositopeni, ateş, renal ve nörolojik anormallikler ile karakterizedir. 14 yaşında kız hasta vücutta morluklar oluşması ve uzamış mens kana­ması nedeniyle hastanemize başvurdu. Fizik muayenede 4 ekstremitede çok sayıda morluk vardı. Laboratuar ça­lışmalarında hemoglobin 9 g/dl, hematokrit %24, beyaz küre sayısı 11.600/mm3, ve trombosit 9.000 mm3 saptan­dı. Bu bulgulara gore ilk tanımız immune trombositopenik purpura oldu ve 2 gün intravenöz immunoglobulin (IVIG) verildi. İki günlük IVIG tedavisine rağmen trombositopeni devam edince kemik iliği aspirasyonu yapıldı. Artmış sa­yıda megakaryositler görüldü. Baş ağrısı, oral bölge ve ekstremitelerde uğuşma, konuşma güçlüğü ve kısa süreli bilinç kaybı gibi nörolojik bulgular oluştu. Trombositopeni­nin devam etmesi ve bazı nörolojik bulguların gözlenmesi nedeniyle hasta tekrar değerlendirildi. Bu bulgularla TTP tanısı kondu ve plazma değişimi tedavisi başlandı. Teda­vinin ikinci gününde trombositlerde yükselme saptandı. Atipik trombositopeni ile başvuran çocuklarda TTP düşü­nülmelidir.

Keywords

• Trombotik trombositopenik purpura, otoimmun tiroidit, trombositopeni, adolesan

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