Long-term treatment of refractory HIV-related immune thrombocytopenia in a patient with haemophilia A.
Haemophilia A patient developed symptomatic immune thrombocytopenia 5 years after HIV seroconversion without any progression of the viral disease. He displayed major bleeding with less than 30 x 10(9) platelets/l. No increase in platelet count was obtained using steroids, azidothymidine and alpha-interferon, while the patient was responsive only to high-dose intravenous immunoglobulins (IVGG). The patient remained responsive to IVGG for 1 year, and the repeated infusions of immunoglobulins were effective in safely maintaining the platelet count, with peak counts above 100 x 10(9)/l. On the contrary, after a single course of six plasma exchanges the patient became symptomatic and completely refractory to IVGG during the next month. In conclusion, IVGG could be effectively used in a long-term regimen in haemophiliacs with refractory HIV-ITP to avoid the risk of haemorrhages and to delay splenectomy.
Fabris
F
F
Istituto di Semeiotica Medica, Università di Padova, Italy.
Mares
M
M
Sartori
M T
MT
Cordiano
I
I
Girolami
A
A
D000328:Adult; D003131:Combined Modality Therapy; D015658:HIV Infections / Q000150:complications*; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D010951:Plasma Exchange; D011241:Prednisone / Q000627:therapeutic use; D013156:Splenectomy; D013921:Thrombocytopenia / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D015215:Zidovudine / Q000627:therapeutic use
D016756:Immunoglobulins, Intravenous; D016898:Interferon-alpha; D015215:Zidovudine; D011241:Prednisone