Farhat Mirna H, Kuriakose Philip, Jawad Michael, Hanbali Amr
Hematology/Oncology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
J Med Case Rep. 2012 Apr 3;6:93. doi: 10.1186/1752-1947-6-93.
Thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura are two well recognized syndromes that are characterized by low platelet counts. In contrast, essential thrombocythemia is a myeloproliferative disease characterized by abnormally high platelet numbers.The coexistence of thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura in a single patient has been reported in the literature on a few occasions. However, having essential thrombocythemia complicating the picture has never been reported before.
We present a case where thrombotic thrombocytopenic purpura, essential thrombocythemia, and idiopathic thrombocytopenic purpura were diagnosed in a 42-year-old African-American woman in the space of a few years; we are reporting this case with the aim of drawing attention to this undocumented occurrence, which remains under investigation.
As the three conditions have different natural histories and require different treatment modalities, it is important to recognize that these diseases may be seen sequentially. This case emphasizes the importance of reviewing peripheral blood smears for evaluation of thrombocytopenia and bone marrow aspirations for diagnosis of thrombocythemia in order to reach an accurate diagnosis and tailor therapy accordingly. Moreover, this case demonstrates the variability and complexity of platelet disorders. This occurrence of three different types of platelet disorders in one patient remains a pure observation on our part; regardless, this does raise the possibility of a common underlying, as yet undiscovered, pathophysiology that could explain the phenomenon.
血栓性血小板减少性紫癜和特发性血小板减少性紫癜是两种公认的以血小板计数低为特征的综合征。相比之下，原发性血小板增多症是一种骨髓增殖性疾病，其特征是血小板数量异常高。文献中曾有少数几次报道过一名患者同时存在血栓性血小板减少性紫癜和特发性血小板减少性紫癜。然而，原发性血小板增多症使病情复杂化的情况此前从未有过报道。
我们报告一例42岁非裔美国女性在几年内先后被诊断出患有血栓性血小板减少性紫癜、原发性血小板增多症和特发性血小板减少性紫癜的病例；我们报告此病例的目的是引起对这种未被记录的情况的关注，目前该情况仍在调查中。
由于这三种病症有不同的自然病程且需要不同的治疗方式，认识到这些疾病可能会相继出现很重要。该病例强调了复查外周血涂片以评估血小板减少症以及进行骨髓穿刺以诊断血小板增多症对于做出准确诊断并据此制定治疗方案的重要性。此外，该病例展示了血小板疾病的多样性和复杂性。一名患者出现三种不同类型的血小板疾病，这在我们看来仍是单纯的观察结果；尽管如此，这确实增加了存在一种共同的、尚未被发现的病理生理学机制来解释这一现象的可能性。
