<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0026-1742</journal-id>
<journal-title><![CDATA[Revista de la Facultad de Medicina (México)]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Fac. Med. (Méx.)]]></abbrev-journal-title>
<issn>0026-1742</issn>
<publisher>
<publisher-name><![CDATA[Universidad Nacional Autónoma de México, Facultad de Medicina]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0026-17422025000600025</article-id>
<article-id pub-id-type="doi">10.22201/fm.24484865e.2025.68.6.03</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Púrpura trombocitopénica trombótica refractaria a tratamiento: reporte de caso]]></article-title>
<article-title xml:lang="en"><![CDATA[Refractory Thrombotic Thrombocytopenic Purpura: A Case Report]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Urbina Castillo]]></surname>
<given-names><![CDATA[Victoria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cantú Velázquez]]></surname>
<given-names><![CDATA[Luisa Guadalupe]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alcantar Martínez]]></surname>
<given-names><![CDATA[Dayana Alexandra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez Velázquez]]></surname>
<given-names><![CDATA[Arturo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Médico Dalinde Departamento de Medicina Interna ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Centro Médico Dalinde Departamento de Hospitalización ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>68</volume>
<numero>6</numero>
<fpage>25</fpage>
<lpage>30</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0026-17422025000600025&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0026-17422025000600025&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0026-17422025000600025&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen La púrpura trombocitopénica refractaria se caracteriza por una disminución persistente o transitoria del recuento plaquetario, lo que conlleva un aumento en el riesgo de sangrados, dependiendo del grado de trombocitopenia. Esta condición es el resultado de un desequilibrio entre la producción de plaquetas por los megacariocitos y su acelerada destrucción. Además, la producción plaquetaria se ve afectada por dos mecanismos principales: 1) destrucción intramedular de plaquetas cubiertas con anticuerpos por parte de los macrófagos y 2) inhibición de la megacariopoyesis. La forma crónica de la enfermedad se define por una duración superior a los seis meses y, aunque pueden ocurrir remisiones espontáneas, estas son poco frecuentes. El presente trabajo tiene como objetivo revisar los factores de riesgo, las manifestaciones clínicas y las opciones terapéuticas disponibles, en relación con el manejo de una paciente de 42 años diagnosticada con esta enfermedad.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Refractory thrombotic thrombocytopenic purpura is characterized by a persistent or passing decrease in platelet count, which increases the risk of bleeding depending on the degree of thrombocytopenia. This condition results from an imbalance between megakaryocyte platelet production and their accelerated destruction. Additionally, platelet production is affected by two main mechanisms: 1) intramedullary destruction of antibody-coated platelets by macrophages and 2) inhibition of megakaryopoiesis. The chronic form of the disease can be described as lasting longer than six months, and while spontaneous remissions may occur, they are infrequent. This manuscript reviews the risk factors, clinical manifestations, and available treatment options for managing a 42-year-old patient diagnosed with this condition.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Púrpura trombocitopénica]]></kwd>
<kwd lng="es"><![CDATA[ADAMTS13]]></kwd>
<kwd lng="es"><![CDATA[plasmaféresis]]></kwd>
<kwd lng="es"><![CDATA[plaquetas]]></kwd>
<kwd lng="es"><![CDATA[rituximab]]></kwd>
<kwd lng="en"><![CDATA[Thrombocytopenic purpura]]></kwd>
<kwd lng="en"><![CDATA[ADAMTS13]]></kwd>
<kwd lng="en"><![CDATA[plasmapheresis]]></kwd>
<kwd lng="en"><![CDATA[platelets]]></kwd>
<kwd lng="en"><![CDATA[rituximab]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="">
<collab>Orphanet</collab>
<source><![CDATA[Púrpura trombótica trombocitopénica]]></source>
<year>2020</year>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sánchez-Luceros]]></surname>
<given-names><![CDATA[A.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Actualización en microangiopatías trombóticas]]></article-title>
<source><![CDATA[Hematología]]></source>
<year>2015</year>
<volume>19</volume>
<page-range>51-8</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Marcone]]></surname>
<given-names><![CDATA[MI]]></given-names>
</name>
<name>
<surname><![CDATA[Colitto]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Ottobre]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Nosetti]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Viviana]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Utilidad de la medición de actividad de ADAMTS13 a propósito de un caso de púrpura trombocitopénica trombótica]]></article-title>
<source><![CDATA[Rev Bioquím Patol Clín (ByPC)]]></source>
<year>2023</year>
<volume>87</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>45-51</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gómez-Almaguer]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Tarín-Arzaga]]></surname>
<given-names><![CDATA[LC]]></given-names>
</name>
<name>
<surname><![CDATA[Pérez]]></surname>
<given-names><![CDATA[JC.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Púrpura trombocitopénica trombótica y síndrome urémico hemolítico]]></article-title>
<source><![CDATA[Hematología. La sangre y sus enfermedades]]></source>
<year>2016</year>
<edition>4</edition>
<publisher-name><![CDATA[McGraw-Hill Education]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lencinas]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Perés]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Aranda]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[de Larrañaga]]></surname>
<given-names><![CDATA[G.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[ADAMTS-13: diagnóstico de laboratorio]]></article-title>
<source><![CDATA[Hematología]]></source>
<year>2020</year>
<volume>24</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>95-100</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Papakaonstantinou]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Kalmoukos]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Mpalaska]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Koravou]]></surname>
<given-names><![CDATA[EE]]></given-names>
</name>
<name>
<surname><![CDATA[Gavriilaki]]></surname>
<given-names><![CDATA[E.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[ADAMTS 13 in the new era of TTP]]></article-title>
<source><![CDATA[Int J Mol Sci]]></source>
<year>2024</year>
<volume>25</volume>
<numero>15</numero>
<issue>15</issue>
<page-range>80137</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zheng]]></surname>
<given-names><![CDATA[XL]]></given-names>
</name>
<name>
<surname><![CDATA[Vesely]]></surname>
<given-names><![CDATA[SK]]></given-names>
</name>
<name>
<surname><![CDATA[Cataland]]></surname>
<given-names><![CDATA[SR]]></given-names>
</name>
<name>
<surname><![CDATA[Coppo]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Geldziler]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Iorio]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[ISTH guidelines for the diagnosis of thrombotic thrombocytopenic purpura]]></article-title>
<source><![CDATA[J Thromb Haemost]]></source>
<year>2020</year>
<volume>18</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>2486-95</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mingot-Castellano]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Pascual-Izquierdo]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Gonzalez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Viejo-Llorante]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Valcarcel-Ferreiras]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Sebastian]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Recommendations for the diagnosis and treatment of patients with thrombotic thrombocytopenic purpura]]></article-title>
<source><![CDATA[Med Clin (Barc)]]></source>
<year>2022</year>
<volume>158</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>630.e1-630.e14</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dimopoulos]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Tripodi]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Goetze]]></surname>
<given-names><![CDATA[JP.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Laboratory investigation and diagnosis of thrombotic thrombocytopenic purpura]]></article-title>
<source><![CDATA[Crit Rev Clin Lab Sci]]></source>
<year>2023</year>
<volume>60</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>625-39</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Siniard]]></surname>
<given-names><![CDATA[RC]]></given-names>
</name>
<name>
<surname><![CDATA[Gangaraju]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[May]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Marques]]></surname>
<given-names><![CDATA[MB.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Challenges in the diagnosis of thrombotic thrombocytopenic purpura]]></article-title>
<source><![CDATA[Expert Rev Hematol]]></source>
<year>2023</year>
<volume>16</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>861-73</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
