MANAGEMENT OF IMMUNE THROMBOCYTOPENIC PURPURA ASSOCIATED WITH THE ANTIPHOSPHOLIPID ANTIBODY SYNDROME

Our two patients had ''primary'' antiphospholipid antibody syndrome wi thout underlying systemic lupus erythematosus or other systemic autoim mune process, as well as symptomatic immune thrombocytopenic purpura ( ITP). The thrombocytopenia did not respond to prolonged courses of cor ticosteroids and/or immune globulin infusions, but was controlled foll owing splenectomy, The presence of serum antibodies to platelet surfac e glycoproteins, typical of ITP, could be helpful in the confirmation of both of these disorders in the same patient, rather than secondary thrombocytopenia. Management of such cases is confounded by an increas ed risk for both bleeding and thrombosis, including fetal death. To re duce the risk of fetal loss and thrombosis, both patients were advised to take aspirin 80 mg daily. The frequency and clinical significance of this association would suggest that patients with ITP should be tes ted for antiphospholipid antibodies, particularly before pregnancy or surgical procedures. Patients with coexistent antiphospholipid antibod y syndrome would be at increased risk for thrombosis in the post-opera tive period following splenectomy and should be given prophylactic ant icoagulation.