Lixelle ameliorates idiopathic thrombocytopenic purpura

Sir, Here we report an interesting case of idiopathic thrombocytopenic purpura (ITP). The case was a male patient born in 1925. He was healthy until he manifested epistasis and proteinuria in 1975. At that time, his platelet count was 0.5310umm. Bone marrow examination revealed normal haematopoiesis with normal megakaryocyte number, consistent with ITP. Anti-DNA antibodies were negative. Renal biopsy was not performed because of bleeding tendency. Steroid was administered without beneficial effects, and tapered later. Although splenectomy was recommended, the patient declined major surgery. Despite conservative treatment, he required maintenance haemodialysis from 1980 (3 daysuweek). Platelet counts were kept low between 0.5 and 1.5310umm after the initiation of dialysis therapy. The patient underwent endoscopic surgery for carpal tunnel syndrome in 1999. Since 2000, we have applied lixelle (1.5 m), a beta2-microglobulin adsorption column (Kanegafuchi Chemicals, Tokyo, Japan), in every dialysis to slow the progression of dialysis-related amyloidosis [1]. Lixelle was set in bloodline prior to the polysulfone dialyser (1.6 m). Dialysis was performed with a total of 1000 U of heparin for 4 h. Blood and dialysate flows were maintained at 200 and 500 mlumin throughout the haemodialysisuhaemoperfusion sessions, respectively. The platelet count gradually increased to 3–5310umm (Figure 1). The frequency of epistasis decreased markedly. In 2002, the platelet count was 4.2310umm. The pathogenesis of ITP appears attributable to autoreactive synthesis of autoantibodies to glycoprotein IIb anduor III on platelets [2]. Platelet-associated IgG (PAIgG) was selected as a probe, because it quantifies the activity of ITP [3]. Exposure to lixelle for 20 min reduced PAIgG by 32% (from 310 to 210 nguml), but not total IgG (from 1160 to 1120 mgudl). Letters