Q. I need a second opinion regarding ITP.

 

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Hi doctor,

My nephew has been unwell since few days. Since two weeks, he has small blood patches on thigh, calves and ankles. Petechial rash and bruising are also present. The doctors have diagnosed him with ITP (idiopathic thrombocytopenic purpura). I am writing to you to get a second opinion. He has been prescribed Prednisone 10 mg three times a day. I have attached his blood profile for your reference. Please help us.

 

 

Answered



Hi,

Welcome to dr.sitehome.info.

  • Isolated low platelet count with normal hemoglobin and CBC (complete blood count) usually is the key laboratory finding for ITP (idiopathic thrombocytopenic purpura) as there in this case. It is the diagnosis of exclusion however.
  • I need few more details about his medical history. Did he ever had gingival bleeding, epistaxis (nose bleeding) or any spontaneous bruising?
  • Any history of dark foul smelling stools or melena?
  • Is there evidence of viral illness like fever or diarrhea or upper respiratory tract infection?
  • Does he have any splenomegaly?
  • ITP is a primary immune mediated destruction of platelets by self-generated antibodies to platelets. It is of two types, acute and chronic.
  • Acute ITP usually follows infection and has spontaneous resolution in eight weeks or two months.
  • Chronic ITP persists longer than six months without any cause.
  • Management includes conservative and observation alone for the one who do not have any signs of bleeding or mild cutaneous manifestations as in this case.
  • In case of any bleeding or life threatening complications I order to suppress immune mediated destruction of platelets which will require IV immunoglobulin, Methylprednisolone and platelet transfusion.
  • As of now he can be managed conservatively and continuous watch on bleeding manifestations should be followed.
  • If the condition persists for more than six months that is if it progresses to chronic ITP then drugs like Eltrombopag and Nplate – Romiplostim can be tried to stimulate platelet production for the one who experience inadequate response to steroids.
  • Now platelet count and bleeding manifestations are to be continuously monitored till it reaches normal and Prednisone dose should be tapered to avoid long term complications of corticosteroids.
  • As I said do watch for bleeding manifestations like large spontaneous bruises, melena, gingival bleeds, gastrointestinal bleeding, altered sensorium and confusion.
  • Do not let him to play as falls may lead to hematomas and internal bleeds. Do not worry. In most cases it resolves spontaneously.

For further information consult a general medicine physician online –> https://www.dr.sitehome.info/ask-a-doctor-online/general-medicine-physician



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