thrombocytopenic purpura

Discussion in 'MRCS Forum' started by Vinay., Mar 26, 2008.

  1. Vinay.

    Vinay. Guest

    A workup for a patient with frequent and multiple areas of cutaneous Ecchymosis discloses a large spleen and evidence of immune (idiopathic) thrombocytopenic purpura (ITP). ITP includes -
    a- A significant enlargement of the spleen
    b- A high reticulocyte count
    c- Megakaryocytic elements in the bone marrow
    d- An increase in platelet count on cortisone therapy
    e- Patient age of less than 5 years
  2. Vinay.

    Vinay. Guest

    Answer: d. (Schwartz, 7/e, pp 1507-1508) patients with ITP who have mild symptoms need no therapy, but they are usually advised to avoid contact sports and elective surgery. When symptoms (e.g. easy bruising, menorrhagia, bleeding gums) are troublesome, the bleeding time will be prolonged, capillary fragility will be greatly increased, and clot retraction will be poor. Corticosteroid therapy increases the platelet count in over 75% of cases and provides the best indication that splenectomy will be of lasting benefit. The platelet count can be expected to rise shortly after splenectomy, and prolonged remissions are anticipated in 80% of cases. The size of the spleen and the state of function of the bone marrow have no predictive value in assessing the likelihood of response to splenectomy. In children, complete spontaneous remissions are common (80% of cases) and surgical intervention should be avoided.

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