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ITP: An Overview of the Conference and Future Directions With an Abbreviated ITP History

THE ABBREVIATED ITP HISTORY The ancient Greeks and Romans (Hippocrates and Galen) recognized skin bleeding and they described red ‘eminences’ or spots associated with pestilential fevers or the plague. Indeed, it is from the Greek word ≅ , (the name of a gastropod mollusc that yields a purple dye) that we get the term purpura. Although the 10 century Persian philosopher and physician Ibn Sinna (Avicenna) described chronic purpura, the association with plague continued until the mid 16 century when Amatus Lusitanus, the peripatetic Converso who, in his seven Centuriae (1541–1561), described an exanthem in a disease called ‘morbus pulicaris absque febre’ (flea-like without fever). A hundred years later, in 1658, Lazarus Riverius, physician to the French king, while writing on pestilential fevers or plague, observed “purple spots like flea-bitings, called by latter physicians ... petechiae ... for in such persons, the blood being made thinner than ordinary, sometimes flows out at the nose, sometimes at some other parts, and sometimes it comes out of the capillary veins into the skin; where being retained, it looseth its own colour and becomes either blueish or black or light red, causing a great variety of spots”. He also noted that this sometimes occurred in the absence of fever. In the following century, Paul Gottlieb Werlhof (poet, composer, linguist and physician to King George III in his Hanoverian possessions) in 1735 provided the classical clinical description of ITP, still sometimes referred to as Werlhof’s disease. He described “an adult girl, robust, without manifest cause, was attacked recently, towards the period of her menses, with a sudden severe hemorrhage from the nose, with bright and foul blood escaping together with a bloody vomiting of a very thick extremely black blood. Immediately, there appeared about the neck and on the arms, spots partly black, partly violaceous or purple, such as are often seen in malignant smallpox”. Three quarters of a century later, in 1808, the English dermatologist, Robert Willan wrote a book, Cutaneous Diseases, describing three types of purpura. Purpura Simplex (the type most consistent with ITP) was characterized “by an appearance of petechiae without much disorder of the constitution. The petechiae are diffused chiefly over the arms, legs, breasts and abdomen. They are largest on the legs, though seldom confluent”. The cause of this disorder he ascribed to “a sedentary mode of life, poor diet, impure air and anxiety of mind”, and, as treatment, he recommended “moderate exercise in the open air, a generous diet, and the free use of wine, Peruvian bark, vitriolic acid, etc”. Although Anton van Leeuwenhoek had invented the microscope in the late 17 century, platelets could not be seen until Joseph Jackson Lister (father of Lord Lister of antiseptic fame), a London wine merchant whose hobby was building microscopes, developed an achromatic microscope in the 1820s. Using such an instrument allowed Alfred Donné in 1842, to write that there are in the blood three species of particles: red cells, white cells, and “globulins du chyle”, the last almost certainly platelets. In 1881, Giulio Bizzozero in Turin provided detailed descriptions of the platelets and, because he recognized the functional and clinical importance of the platelet, he became designated as the “father of the platelet”. However, despite his work’s title (Sur en nouvel element morphologique du sang ... 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. In 1883, Georges Hayem in Paris actually coined the term, platelet. Hayem studied platelets and their function intensively and developed a method for quantifying platelets in blood. Shortly thereafter it was recognized (for example by Joseph Denys in Louvain in 1887) that purpura was associated with low platelet counts. In 1890, Howell at the University of Michigan recognized megakaryocytes in the bone marrow and described their function and in 1906 James Homer Wright of Harvard University wrote on “the origin and nature of the blood plates” (sic!) Received for publication October 9, 2003; accepted October 13, 2003. From the Toronto Platelet Immunobiology Group (T-PIG), St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada. Reprints: Dr. John Freedman, Director, Transfusion Medicine, St. Michael’s Hospital, 30 Bond St., Toronto, Ontario, Canada M5B 1W8 (e-mail: freedman@smh.toronto.on.ca) Copyright © 2003 by Lippencott Williams & Wilkins