John Freedman
John W Semple
Valery Leytin
Margaret L Rand
SMH
Alan H Lazarus
Heyu Ni
Victor S Blanchette
HSC
CBS
ITP
Idiopathic thrombocytopenic purpura
Immune thrombocytopenic purpura
From Hippocrates to Bussel
(and a few side-trips in between)
purpura
immune
thrombocytopeni
a
Greco-Roman: Hippocrates, Galen –
life based on four elements: Fire, air, earth, water
Blood was one of the four ‘humors’ (air): made in
liver, sloshed around through heart where mixed with air
Brew of willow tree leaves (salicylates) as analgesic
and antipyretic
Spleen: source of black bile; “organ full of mystery”
Hippocrates
460-377 BCE
Red “eminences”/spots associated
with pestilential fevers (plague).
Galen
CE 129-circa 210
[Juliana Anicia Ms, CE 487]
Purpura
πορφυρα
Porphyra
Gastropod mollusc
janthina janthina
C10th: Avicenna (Canon) --- chronic purpura
Amatus Lusitanus (Jono Rodrigues de Castelo Branco)
[1511-1568]
Physician, researcher in anatomy, internal medicine, dermatology, mental illness.
Peripatetic Converso who fled from Salamanca to Portugal, Ferrara, Ancona, Dubrovnik,
Salonika, but was nonetheless physician to several monasteries and to Pope Julius III.
Between 1541 and 1561 wrote seven centuriae: each 100 case histories, their treatment,
results and pathology, accompanied by learned explanations.
1658
Anton van Leeuwenhoek
X 300
1632-1723
1735
poet
composer
linguist
physician
1775
1808
The Englishman, William Hewson (1739-1774) was
probably the first to observe some platelets.
1828
Joseph Lister, Lord
Joseph Jackson Lister
1827-1912
1786-1869
Founder of aseptic surgery
Wine merchant
1842
Alfred Donne (1801-1878)
Child care; breastfeeding
+ Foucault = daguerrotype
1840s to 1860s:
Gulliver, Addison: independently made what are
probably the first drawings of platelets
Addison 1842
Zimmerman: ‘elementary bodies’ which came from
lymphatics and were precursors of red blood cells;
(Hematoblasts)
Jones, Beale, Simon, Schultze: platelets were fibrin clots
(? derived from leukocytes)
Schmidt in Estonia:
? A cell between erythrocyte
and leukocyte
Professor of Anatomy,
Bonn
Brewer DB: Br J Haematol 133:251-258, 2006
1874
Osler
Aequanimitas
“It must still
be confessed
that we know
nothing about
the origin or
destiny of
these
corpuscles”
1882
“The existence of a constant blood particle, differing from red and
white blood cells, has been suspected by several authors for some time”
Despite the work’s title (“…et sur son importance dans
la trombose et dans la coagulation”), Bizzozero did not focus
on the hemostatic or hemorrhagic role of platelets, and
appears not to have recognized platelets as a factor in purpura.
Georges Hayem (1841-1935):
A founder of haematology.
rbc
platelets
Small elements in blood; tendency
to clump and to change shape;in
1883, coined term platelet.
Hôpital Tenon; St Antoine: several anemias, digestion, stomach, rbc counting, cholera
In 1884, Krauss related purpura hemorrhagica to a
decrease in circulating platelets
1887
1895
1890
Relation of megakaryocytes to platelets
Take off full screen
1915: Frank (Breslau) recognized that megakaryocytopoiesis
was normal in ITP
1915
1916
Minot
Failure of transfusion in ITP
1916
Minot
Platelet destruction due to “some reaction”
1916
Kaznelson
(Prague)
Spleen site of platelet destruction?
Splenectomy in ITP
Other treatments at this time included irradiation by mercury vapor
lamps, snake venom, splenic irradiation.
Troland & Lee ‘Thrombocytopen’ from ITP splenic extracts
Platelet count
1938
Damashek & Miller, however, continued to argue that
ITP was due to a fundamental abnormality of the
spleen which ‘exerts an unusual effect on the
production of platelets from the megakaryocytes in
the marrow’
1940
Wiseman
Clinical diagnostic criteria for ITP
1946
Curtis
Failure of splenectomy due to
accessory spleen
1951 Passive transfer of ITP with ITP plasma
plasma
Carl V Moore
Harrington et al, J Lab Clin Med 38:1, 1951
1951
Evans
Plasma factor = anti-platelet antibody
1951
Damashek
Distinction of acute versus chronic ITP
1951
Wintrobe
Use of corticosteroids in ITP
William Damashek
Maxwell Wintrobe
1984: First randomized trial of steroids in ITP
1972 --- Sartorius, Am J Ped Hematol Oncol 6:165, 1984
1970s
Lien
1975
Dixon
Measurement of PA-IgG
1981
Imbach
IVIG in ITP
1983 Salama
Anti-D in ITP
1970s – 1990s
Humoral immunity in ITP; antibody specificity
New drugs for refractory patients
1990s -
Dysregulation of cellular immunity in ITP
Literature on history of platelets
Jones HW, Tocantins LM: The history of pupura hemorrhagica. Ann Med Hist 5:349-359, 1933.
Robb-Smith AHT: How the platelets were discovered. Br J Haematol 13:618-639, 1967.
Blanchette M, Freedman J: The history of idiopathic thrombocytopenic purpura (ITP).
Transfus Sci 19:231-236, 1998.
Freedman J, Blanchette M: Idiopathic thrombocytopenic purpura (ITP): a historical odyssey.
Acta Paediatr Suppl 424:3-6, 1998.
Mustard JF, Kinlough-Rathbone RL, Packham MA: History of platelets. In: Platelets in
thrombotic and nonthrombotic disorders: pathophysiology, pharmacology and therapeutics. Gresele
P, Page C, Fuster V, Vermylen J, eds. Cambridge University Press, Cambridge, 2002.
Imbach P, Kuhne T, Signer E: Historical aspects and present knowledge of idiopathic
thrombocytopenic purpura. Br J Haematol 119:894-900, 2002.
 Izaguirre-Avila R: El descubrimiento de las plaquetas. Revista Biomedica Vol 8, 1997.