Mitral valve replacement in a patient with idiopathic thrombocytopenic purpura: preoperative treatment with danazol.

A 64-year-old woman with refractory idiopathic (autoimmune) thrombocytopenic purpura required urgent mitral valve replacement. Preoperative therapeutic interventions to raise dangerously low platelet counts were unsuccessful until danazol therapy was institued. Danazol therapy was associated with elevation of the platelet count to greater than 125 x 10(9)/L and allowed successful mitral valve replacement and left atrial thrombectomy to be performed. Postoperative bleeding was average and blood product replacement was not excessive. This case of mitral valve disease in a patient with idiopathic (autoimmune) thrombocytopenic purpura is unique, because perioperative hemostasis was accomplished using danazol and splenectomy was not required.