The Purpura Shadow

I have not been more scared in my whole life than that cold day of winter in 1994. It was the time when I was going from Tuscaloosa to Birmingham, in an ambulance with Yadhi on her eight month of pregnancy. That day ITP became a top priority in my research. I was on a sabbatical leave from my university in Mexico were I was involved in Chemical Research, far from any true clinical relevance. I arrived as a visiting scholar to the University of Alabama; to which I am grateful now, for the opportunity to learn a great deal about ITP, Cancer and other inflammatory diseases.

One day Yadhi and I went for a pregnancy check and the doctors were surprised by a lot of red spots in Yadhi´s legs. Although somewhat common during pregnancy, ITP was not unfamiliar for Yadhi; she had been in the hospital several times since childhood and 2 years before she had a splenectomy. When she first took the blood test at Tuscaloosa, I did not have any idea what a low platelet count meant. However, for Yadhi, petechiae were known symptoms of trouble. The doctors quickly set an appointment to the Cancer Center of DCH (Druid City Hospital), were very good hematologists took care of us. The 9,000 platelets count of Yadhi immediately made an emergency situation and without thinking we where on our way to Birmingham. The old corticoids therapy was back again and a treatment of IVIgG was carried out. We were on the hospital for 7 days. The well-known Medical School of the University of Alabama at Birmingham, opened the doors of its Library for a lot of reading on ITP. Every day I expended several hours finding articles and going back to Yadhi´s room to find out how much she knew about the disease herself.

The platelets rose to almost 35,000 and we were sent back to Tuscaloosa. The platelets were down again after 2 weeks, and a new treatment of IVIgG was started on Friday and continued over the weekend as an outpatient visitor to the hospital. Early on Monday contractions began and labor was on its way. Yadhi was admitted to the hospital around 9:30 AM and a crew of specialists was always in contact with us. The hours went by and a monitor was installed on the baby's scalp to see how he was doing. By 6:00 AM on Tuesday, the transition phase started and things became rather frantic. At 7:21 AM of February 8th 1994, a beautiful baby boy was born and was taken to the neonatal care unit to check on his platelets. Unfortunately, he had neonatal ITP, so then I had to worry for two instead of one.

The delivery was vaginal and the platelet count of 50,000 let us foresee no complications of heavy bleeding. However, the platelets of Enrique, our son, were coming down from 50,000 to 40,000 to 35,000, into a very risky situation for a baby. Yadhi recovered herself rather quickly and was breastfeeding the baby and spending as much time as possible with him. The blood type of Enrique turned out to be A negative, a very uncommon blood type in southeast USA, so things were more complicated when Enrique needed a transfusion. He was on prednisone and when things were at its very bad point and we could not get any blood. However, he started to respond without the blood transfusion. The prednisone was tampered slowly and his platelets were counted every 2 weeks for 3 months. The antiplatelets antibodies of his mother were transferred to him through the umbilical cord, but the neonatal ITP was resolved with no further complications for our son. He left the hospital after three weeks of difficult times.

However, Yadhi´s situation was getting more complicated. The highly stressful situation was worsening her ITP. Several alternatives were attempted, since IVIgG is a very expensive treatment and only holded her platelets for 2 weeks; Danazol, vincristine and vinblastine were also tried. The many trips to the Cancer Center for chemotherapy were also used by me for more research in the library. The search for an effective and inexpensive treatment was always on my mind.

The doctors at DCH were very discouraged after the chemotherapy since it was not working at all. We were transferred back to Birmingham to the Kirklin Clinic where a lot of experience and research in dealing with platelet abnormalities, was an ongoing effort. The searching for anomalies in the surface of the platelets was investigated to see if Yadhi had the Bernard-Soulier Syndrome, but apart from testing and finding an extremely long coagulation time, nothing really emerged from our trips to Birmingham. The chemotheraphy has been very hard on Yadhi´s hair, so we were very close to find a wig. She tried many, but they did not fit very well. Nothing appeared to be working.

A ceremony in our church during May 1994 gave me part of the clue. "Give to the Lord the chance to heal you but help him too" said our priest. I decided then to stop all the treatments and begin our own. One day we were seeing, "Medicine Woman"(Dr. Quinn) on TV, and a soldier was examined and diagnosed scorbutic after seeing his legs. The key word Petechiae pop out. The next day I went to the library to learn about scurvy and I found the picture of the legs of a Russian soldier of WW I. The legs were the same as Yadhi´s when we were in the ambulance. I though, how about an induced scurvy state?. This, and some reports of the use of vitamin C in the treatment of ITP encourage me to try a megadose of Vitamin C.

By this time I had read some of the books of my chemical hero Dr. Linus Pauling, and convinced myself that I was on the right track since I had some previous experience with the chemistry of Vitamin C. I learned also that vitamin E helps vitamin C, so we started a combined therapy that restored Yadhi´s platelets into a safe count of about 80,000 in 3 weeks. The dose was tampered to 500mg/day for about a year, and now back in Mexico we have a lovely daughter who was born in 1996, with no complications. Today, with a platelet count of 299,000, we are expecting another baby very soon. For me, the purpura shadow will be always present until a complete understanding of ITP could be achieved. My research will never be the same after this intense experience. The closest suffering to an ITP patient suffering is the one felt for the people in love with one.

2009 UPDATE:

Yadhi continues to do well and Enrique is helping many people. Visit their web site www.cclpuebla.com.mx (in Spanish). We will publish additional information soon.

-- Enrique

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