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Splenectomy and Steroid in Thrombocytopenic Purpura

Peter V. Sacks, MD
JAMA. 1974;228(8):975. doi:10.1001/jama.1974.03230330017004.
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To the Editor.—  The encouraging survival figures published by Cuttner (227:397, 1974) and by Goldenfarb and Finch (226:644, 1973), raise the question of the way in which splenectomy and high-dose steroid influence the course of thrombotic thrombocytopenic purpura (TTP).Disseminated intravascular coagulation does not seem to be a primary factor in the pathogenesis of TTP, and heparin has no effect on the course of the disease.1 The fundamental disturbance would appear to be primary blood vessel damage,2 with secondary adhesion of platelets, vascular occlusions, and mechanical red blood cell damage (microangiopathic hemolysis). Drugs that reduce platelet adhesiveness may be expected to exert a beneficial effect on the disorder. A number of clinical reports claim successful therapy using aspirin and dipyridamole3 or aspirin alone.4 It is possible that vascular damage in TTP may be immunologically mediated, although the "trigger" agent or mechanism remains obscure. The pathogenesis has been compared


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