Frequently relapsing thrombotic thrombocytopenic purpura treated with cytotoxic immunosuppressive therapy.
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Treatment of thrombotic thrombocytopenic purpura (TTP) with plasma exchange has reduced mortality rates from 90% in untreated cases to less than 20%. Despite plasma exchange, relapses may occur in as many as 40% of cases. Multiple relapses occur in a minority but pose a significant therapeutic challenge. Recent evidence supports the presence of an autoantibody which inhibits proteolysis of von Willebrand factor (vWF) in active TTP, allowing large multimers of vWF to form and promote platelet aggregation. Additional evidence suggests autoantibodies activate capillary endothelium and promote platelet aggregation in the microcirculation. Immunosuppression, thus, has a biologically plausible role in TTP. We describe three consecutive cases of relapsing TTP treated with cytotoxic therapy to highlight the potential role of immunosuppression. DESIGN AND METHODS: Cytotoxic immunosuppressive therapy with either cyclophosphamide or azathioprine was used in three consecutive patients with frequently relapsing TTP. RESULTS: All three patients have maintained remissions of 8 to 10 months without recurrence. INTERPRETATION AND CONCLUSIONS: Cytotoxic immunosuppressive therapy may have a role in inducing long-term remissions in recurrent TTP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".