Garcia-Hejl C, Fagot T, Foissaud V, Samson T, Defuentes G, Clavier B, Perez J-P, de Revel T
Laboratoire de biologie, HIA Percy, Clamart.
Ann Biol Clin (Paris). 2008 May-Jun;66(3):327-31. doi: 10.1684/abc.2008.0206.
We report a case of thrombotic thrombocytopenic purpura (TTP) in a 60 years-old woman with Sjogren's syndrome. Symptomatology on admission leads to evoke the diagnosis of TTP. Biological results allow to set the diagnosis. Actually, association of haemolytic anaemia, schizocytes and thrombocytopenia are in favour of TTP. Undetectable ADAMTS 13 activity (below 5%) confirms the diagnosis. In congenital TTP, plasma ADAMTS 13 is absent or severely reduced as a consequence of mutations in the two ADAMTS 13 gene. In acquired TTP, circulating antibodies inhibit plasma ADAMTS 13 activity. In those cases, further biological studies are needed to find a cause of TTP. Follow-up implies standard laboratory tests. Plasma exchanges are progressively tapered after normalization of platelets count.
我们报告了一例患有干燥综合征的60岁女性血栓性血小板减少性紫癜(TTP)病例。入院时的症状表现提示TTP的诊断。生物学检查结果有助于确诊。实际上,溶血性贫血、裂红细胞和血小板减少同时出现支持TTP的诊断。检测不到ADAMTS 13活性(低于5%)则进一步证实了诊断。在先天性TTP中,由于ADAMTS 13基因的两个突变,血浆中ADAMTS 13缺失或严重减少。在获得性TTP中,循环抗体抑制血浆ADAMTS 13活性。在这些病例中,需要进一步的生物学研究以找出TTP的病因。随访需要进行标准的实验室检查。血小板计数恢复正常后,血浆置换逐渐减量。