Difficulties in the management of an incomplete form of refractory thrombotic thrombocytopenic purpura, the usefulness of vincristine

Background: Although several etiologies can be identified in thrombotic thr ombocytopenic purpura (TTP), idiopathic cases are still frequent. Incomplet e forms are more rare. Currently, the diagnosis may be made in cases of thr ombocytopenia and microangiopathic hemolytic anemia. According to the liter ature, mortality and morbidity are significantly improved with plasma excha nge. However, treatment in refractory forms remains problematic. Case report: A 33-year old woman presented with an incomplete form of TTP, refractory to a combination of therapeutics. The patient underwent plasma i nfusion, plasma exchange, and then was started on corticosreroids. She also received intravenous immunoglobulins and antiplatelet agents in close prox imity to vincristine (Oncovin(R)) infusion. The main biological indicators used were the platelet count, hematocrit, LDH, and the presence of schistoc ytes; Following vincristine treatment, the patient's condition rapidly impr oved. Conclusion: Vincristine administered after the failure of standard therapeu tics was effective in this refractory form of TTP. (C) 2000 Elsevier Scienc e Ltd. All rights reserved.