Asociación de la púrpura trombocitopénica inmunológica y el síndrome de Guillain-Barré: a propósito de un caso / Association of immunologic thrombocytopenia and the Guillain-Barré syndrome: with regard to a case

La púrpura trombocitopénica inmunológica es una enfermedad autoinmune, benigna, de aparición frecuente, caracterizada por la presencia de anticuerpos dirigidos contra las glicoproteínas de la membrana plaquetaria que producen una disminución del recuento plaquetario y manifestaciones hemorrágicas cutáneo-mucosas. El diagnóstico de esta entidad se realiza por exclusión de otras causas de trombocitopenia. El síndrome de Guillain-Barré es también una enfermedad de naturaleza autoinmune donde la pérdida de la tolerancia inmunológica trae como consecuencia la aparición de anticuerpos dirigidos contra los gangliósidos de los nervios periféricos. Se presenta una paciente femenina de 40 años con diagnóstico de una púrpura trombocitopénica inmunológica crónica que comenzó con una parálisis motora ascendente, sin toma respiratoria, parálisis facial y dolor intenso en las regiones dorsal y lumbar. Fue diagnosticada como un síndrome de Guillain-Barré e inmediatamente se comenzó tratamiento con vitaminoterapia y esteroides a altas dosis. Después de varios meses de seguimiento y rehabilitación presentó una evolución satisfactoria con remisión de todos los síntomas neurológicos

The immunologic thrombocytopenic purpura is an autoimmune, benign, of frequent appearance disease characterized by the presence of antibodies directed to glycoproteins of platelet membrane producing a decrease of platelet count and cutaneous-mucosal hemorrhagic manifestations. The Guillain-BarrÚ syndrome is also a disease autoimmune by origin where the loss of immunological tolerance causes the appearance of antibodies directed to gangliosides of peripheral nerves. This is the case of female patient aged 40 diagnosed with a chronic immunologic thrombocytopenic purpura beginning with an ascendant motor paralysis, without respiratory compromise, facial paralysis and intense pain in dorsal and lumbar regions and also a diagnosis of Guillain-BarrÚ syndrome with immediate treatment based on vitamin-therapy and high dose of steroids. After some months of follow-up and rehabilitation there was a satisfactory evolution with remission of all neurological symptoms

Outcome of refractory autoimmune thrombocytopenia purpura treated with autologous peripheral blood stem cell transplantation / 基础医学与临床

Objective To explore the efficacy and immune reconstitution of autologous peripheral blood stem cell transplantation (APBSCT) in the treatment of refractory autoimmune thrombocytopenia purpura (ITP). MethodsOne patient with refractory ITP was treated with APBSCT, the effectiveness and the process of immune reconstitution were analyzed retrospectively. Results The case was mobilized by cyclophosphamide (CY) plus G-CSF and 4.7?106/kg CD34+ cell was gained totally. Neutrophil and platelet were engrafted at 11th and 12th day without severe complications following the conditioning of TBI and CY. Although the each phenotype of the peripheral blood lymphocytes recovered gradually 6 months after the transplant,inverted CD4/CD8 ratio exited and memory T cell was improved much earlier than naive T cell. The platelete count was constantly over 100?109/L and the patient was in complete remission after a follow-up of 31 months.Conclusion APBSCT is a potential approach in the treatment of refractory ITP.