Ruiz-Sáez Arlette, Sifontes Luz Núñez, Feijoo Rosa, Certad Gabriela, Arenas-Pinto Alejandro, Pocaterra Leonor, Ferrara Guiseppe, Giménez Rita, Torres Obdulita, Goldstein Carlos, Bosch Norma
Banco Municipal de Sangre del Distrito Capital, Caracas, Venezuela.
Am J Trop Med Hyg. 2005 Aug;73(2):381-5.
Platelet dysfunction was detected in six children with purpura and eosinophilia. We conducted clinical evaluations, hematologic and platelet function tests, clotting studies (bleeding time, prothrombin time, partial thromboplastin time, thrombin time, factor XIII, factor VIII, and von Willebrand factor), assays for IgG and IgM antibodies to platelets, and a search for stool parasites. Mild bleeding phenomena (ecchymoses, petechiae, epistaxis, and gingival) were transient. All children showed intestinal parasites and marked eosinophilia (mean count = 2,615.2 cells/muL, 95% confidence interval = 1,259.6-5,429.8). Main abnormalities included prolonged bleeding times (50%) and defective aggregation with collagen (100%) adrenaline (66%), or ADP (66%). Antibodies to platelets were not detected. Anti-parasite therapy reversed the hemorrhagic manifestations and normalized eosinophil counts and platelet alterations. No relationship could be established between excess eosinophils, intensity of bleeding, or type and degree of platelet abnormalities. Thrombocytopathic features mimicked the intrinsic defect of storage pool disease. The possible pathogenic roles of eosinophilia and parasitism are reviewed. This is the first report of this pathologic combination in Latin American children.
在6名患有紫癜和嗜酸性粒细胞增多症的儿童中检测到血小板功能障碍。我们进行了临床评估、血液学和血小板功能测试、凝血研究（出血时间、凝血酶原时间、部分凝血活酶时间、凝血酶时间、因子 XIII、因子 VIII 和血管性血友病因子）、血小板 IgG 和 IgM 抗体检测以及粪便寄生虫检查。轻度出血现象（瘀斑、瘀点、鼻出血和牙龈出血）是短暂的。所有儿童均显示肠道寄生虫和明显的嗜酸性粒细胞增多（平均计数 = 2,615.2 个细胞/微升，95% 置信区间 = 1,259.6 - 5,429.8）。主要异常包括出血时间延长（50%）以及与胶原蛋白（100%）、肾上腺素（66%）或 ADP（66%）的聚集缺陷。未检测到血小板抗体。抗寄生虫治疗逆转了出血表现，使嗜酸性粒细胞计数和血小板改变恢复正常。在嗜酸性粒细胞增多、出血强度或血小板异常的类型和程度之间无法建立关联。血小板病特征类似于储存池病的内在缺陷。对嗜酸性粒细胞增多和寄生虫感染的可能致病作用进行了综述。这是拉丁美洲儿童中这种病理组合的首次报告。
