New strategies in diagnosis and treatment of thrombotic thrombocytopenic purpura: case report and review.
The pentad of thrombocytopenia, haemolytic anaemia, mild renal dysfunction, neurological signs and fever, classically characterizes the syndrome of thrombotic thrombocytopenic purpura (TTP). TTP usually occurs in adults but also children have been described with this condition. The disorder may take a relapsing course, termed chronic relapsing TTP (CRTTP), which although very rare, may also begin in childhood. Deficiency of a recently identified enzyme, the von Willebrand factor (vWF)-cleaving protease, seems to play a major role in the development of TTP. We report on a 3-year-old boy with a dramatic but typical clinical course of CRTTP. At the time of diagnosis, neurological deficits and multiple cerebral infarctions had already occurred. In plasma, vWF-cleaving protease was completely absent, both during acute TTP and in remission. There was no protease inhibitor detected. Regular infusions of fresh frozen plasma were successfully given for replacement on a prophylactic basis.


CONCLUSIONS
Assay of von Willebrand factor-cleaving protease helps to diagnose a form of thrombotic thrombocytopenic purpura which may be managed by prophylactic treatment with fresh frozen plasma.
Häberle
J
J
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Germany. haeb@uni-muenster.de
Kehrel
B
B
Ritter
J
J
Jürgens
H
H
Lämmle
B
B
Furlan
M
M
D001780:Blood Coagulation Tests; D016913:Blood Component Transfusion / Q000379:methods*; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010949:Plasma; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014841:von Willebrand Factor / Q000032:analysis*
D014841:von Willebrand Factor