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IDIOPATHIC THROMBOCYTOPENIC PURPURA AND MENORRHAGIA MISTAKENLY TREATED FOR LOCAL DISEASE:  Report of Four Cases

WILLIAM DAMESHEK, M.D.; JACK J. RHEINGOLD, M.D.
JAMA. 1949;139(15):993-996. doi:10.1001/jama.1949.02900320023007.
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That profuse and prolonged bleeding from the uterus may occur in idiopathic thrombocytopenic purpura has long been known. Indeed, menorrhagia may be the earliest manifestation of the disease and on occasion its only symptom. However, excessive menstrual bleeding is all too often considered as being due to purely local causes, with the result that such procedures as dilation and curettage of the cervix and even hysterectomy have been performed. The observation of 4 such cases in the period of a few months, the underlying disease in each instance being idiopathic thrombocytopenic purpura, brought this situation acutely to mind. In 3 of the 4 cases studied, dilation and curettage of the uterus had been performed at least once, and in the fourth case hysterectomy had been done. The simple procedure of studying a blood smear for blood platelets would have revealed the almost complete lack of these cellular elements and thus

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