Thrombotic thrombocytopenic purpura (TTP) - HIV Infection

3/03/2003

Question: How is TTP recognized and treated in an HIV-positive patient?

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Unique Identifier:10027100

Authors: Sutor GC. Schmidt RE. Albrecht H.

Institution: Medizinische Hochschule Hannover, Zentrum Innere Medizin, Germany.

Title: Thrombotic microangiopathies and HIV infection: report of two typical cases, features of HUS and TTP, and review of the literature. [Review] [45 refs]

Source: Infection. 27(1):12-5, 1999 Jan-Feb.

Abstract: Haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are thrombotic microangiopathies increasingly reported in patients with HIV infection. However, characteristic features of thrombotic microangiopathies associated with HIV disease have not been defined yet. The typical courses of HUS and TTP in two patients are presented. The data as well as the analysis of cases published in the literature demonstrate the association of thrombotic microangiopathies with late-stage HIV disease. Moreover, differences between HUS and TTP can be detected. Patients with HUS present with more severe immunologic deterioration. Although clinical symptoms are fewer, HUS implicates a very poor prognosis. Life expectancy rarely exceeded 1 year after diagnosis. HUS and TTP should therefore be added to the international AIDS classification. [References: 45] CAS Registry/EC Number 0 (Anti-Inflammatory Agents, Non-Steroidal). 0 (Salicylates).

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Unique Identifier:7817233

Authors: Chu QD. Medeiros LJ. Fisher AE. Chaquette RF. Crowley JP.

Institution: Department of Medicine, Rhode Island Hospital, Providence 02903.

Title: Thrombotic thrombocytopenic purpura and HIV infection.[comment]. [Review] [21 refs]

Source: Southern Medical Journal. 88(1):82-6, 1995 Jan.

Abstract: We report on a man who was HIV-seropositive and who was initially admitted following multiple episodes of syncope. He gradually developed fulminant thrombotic thrombocytopenic purpura (TTP). Twenty-one patients with TTP who were HIV-positive have been reported previously. Of these 22 patients, all treated with plasmapheresis, 7 died from TTP and 3 suffered relapse but eventually recovered. Delay in initiating plasmapheresis may be fatal. We have correlated the laboratory data of these patients at time of admission with subsequent clinical outcome; only the platelet count correlated with outcome. Patients with lower platelet counts were less likely to relapse or die with therapy. Physicians caring for patients infected with HIV should always consider the possibility of TTP in those patients with thrombocytopenia of unknown etiology. Review of the peripheral blood smear, allowing the detection of microangiopathic hemolytic anemia, is an important clue, enabling one to consider the correct diagnosis. [References: 21]

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Unique Identifier:7926980

Authors: Cruccu V. Parisio E. Pedretti D. Villa A. Confalonieri F.

Institution: III Medical Department, Fatebenefratelli-Oftalmico Hospital, Milan, Italy.

Title: HIV-related thrombotic thrombocytopenic purpura (TTP) as first clinical manifestation of infection.

Source: Haematologica. 79(3):277-9, 1994 May-Jun.

Abstract: A case of thrombotic thrombocytopenic purpura (TTP) in a 40-year-old bisexual man unaware of being HIV positive is reported. The hematologic syndrome represented the first clinical manifestation of this viral infection. The clinical picture, characterized by severe hemolytic microangiopathic anemia, thrombocytopenia, fluctuating neurologic abnormalities and fever, quickly improved after plasma exchange and corticosteroid therapy. Two blood tests showed severe depletion of the CD4+ lymphocyte count and HIV antigenemia was positive. This case represents a clinical epiphenomenon of HIV infection in an advanced phase. According to recent CDC criteria the patient should be considered in AIDS. Antiretroviral treatment was started and after nine months of follow-up there has been no relapse.

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Unique Identifier:8217798

Authors: Garcia-Suarez J. Prieto A. Reyes E. Manzano L. Merino JL. Alvarez-Mon M.

Institution: Servicio de Hematologia, Hospital Universitario Principe de Asturias, Universidad de Alcala de Henares, Madrid, Spain.

Title: The clinical outcome of autoimmune thrombocytopenic purpura patients is related to their T cell immunodeficiency.

Source: British Journal of Haematology. 84(3):464-70, 1993 Jul.

Abstract: In this work we have furthered the understanding of the alterations of T lymphocytes from 29 patients with active autoimmune thrombocytopenic purpura (ATP) and the clinical significance of their lymphocytes. An increased percentage of in vivo activated (CD25+ and DR+) T lymphocytes was found in ATP patients with respect to that found in 22 healthy controls. The function of these T cells measured as the proliferative response to polyclonal mitogenic signals is heterogeneously impaired in ATP patients. T lymphocytes from 65.5% (19/29) of the ATP patients showed a decreased proliferative response to these mitogenic signals. This functional alteration is associated with a redistribution of the T cell compartment in these patients' peripheral blood since a significant decrease of CD4+ T lymphocytes was found. We have also found that the impairment of the T cell function is different in the diverse clinical situations of the disease. Those with stable, untreated disease showed a marked decrease in the T cell proliferative response to mitogens. Furthermore, those patients who did not respond either to steroids or to splenectomy showed significantly reduced T lymphocyte blastogenesis after phytohaemagglutinin (PHA) stimulation in comparison to that found in responding patients. CAS Registry/EC Number 0 (Antigens, CD).