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Hugh C. Kim, MD; Karel Raska, Jr, MD; Stanley Trooskin, MD; Parvin Saidi, MD

Arch Intern Med. 1989;149(7):1685-1688.

Abstract
• We studied five patients with hemophilia A in the age range of 18 to 64 years who were infected with human immunodeficiency virus and who developed immune thrombocytopenia. The clinical course of immune thrombocytopenia in relation to human immunodeficiency virus infection and the patients' responses to splenectomy and immune variables were determined. All five patients developed antibody to human immunodeficiency virus 6 to 60 months (median, 24 months) before the onset of thrombocytopenia, and two patients became human immunodeficiency virus antigenemic (one patient at the onset of immune thrombocytopenia and the other 60 months after the onset of immune thrombocytopenia [24 months after splenectomy]). All five patients had a strong platelet-associated immunoglobulin G and three patients also had a weak plateletassociated immunoglobulin M on their platelets. In four of five patients danazol therapy failed, and three patients required moderate doses of prednisone. Because of the progression of immune thrombocytopenia, four of the five patients underwent splenectomy with preoperative high-dose intravenous immune globulin. All four had an excellent immediate response to splenectomy, with a rise in platelet count to more than 300 x 10⁹/L and sustained remission during postsplenectomy follow-up of 6 to 45 months. There was no significant drop in CD4 and CD8 counts after splenectomy, and all four patients remained clinically well.

(Arch Intern Med. 1989;149:1685-1688)

Author Affiliations
From the Departments of Medicine (Drs Kim and Saidi), Pathology (Dr Raska), and Surgery (Dr Trooskin), University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ.

Footnotes
Accepted for publication December 16, 1988.

Reprint requests to Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, 1 Robert Wood Johnson PI, CN 19, New Brunswick, NJ 08903 (Dr Kim).

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