Idiopathic thrombocytopenic purpura ? - thrombocytopenic purpura more condition_symptoms
I had idiopathic thrombocytopenic purpura (ITP), when I was 2 years. Are there consequences for the life that I should know?
Wednesday, November 4, 2009
Thrombocytopenic Purpura More Condition_symptoms Idiopathic Thrombocytopenic Purpura ?
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, A higher probability of pathology.
Diagnosis of ITP is a clinical diagnosis of exclusion. Low platelet count may be a feature of many diseases and, where appropriate, warrants one, by a haematologist. Secondary causes such as leukemia, medications (eg quinine, heparin), lupus erythematosus and other autoimmune diseases, cirrhosis (which leads to thrombocytopenia, hypersplenism), HIV, congenital and antiphospholipid syndrome. An examination of the bone marrow can be done over 60 years and those who do not respond to treatment in patients, or if the diagnosis is in question.
Despite the destruction of platelets by macrophages in the spleen, the spleen is not extended, as a rule. In fact, an enlarged spleen should lead a doctor to ensure that examine other possible causes of thrombocytopenia.
Accelerated training of platelets results in the presence of abnormally large platelets, both the peripheral blood. Total bleeding time is prolonged in these patients, but the prothrombin time (PT) and partial thromboplastin (PTT) are normal (because the problem with the pads and is not), the coagulation cascade.
Sometimes, autoimmune hemolytic anemia and immune thrombocytopenic purpura in May next to each other, which is a so-called Evans syndrome.
Treatment
Mild ITP require no treatment. When platelets below 10,000 per microliter or less than 50,000 if bleeding (eg gastrointestinal tract, or severe bleeding, treatment of the nose occurs), usually begins with steroids. Intravenous immunoglobulin (IVIG) is used for business and life. Later, the so-called steroid agents, diuretics (used to be called FAME) can be. If these strategies do not, a splenectomy (removal rate) is usually performed, such as platelets are often targeted for destruction to meet his fate in the spleen. A relatively new approach is treatment with anti-D, an agent in mothers who are sensitized to the Rh-antigen for Rh + baby, but the patient must be Rh +. Immunosuppressants such as mycophenolate mofetil and azathioprine are increasingly popular For efficacy. Rituximab has been used with success in some patients.
The extreme cases (very rare, very rare in children) May require vincristine, a chemotherapy drug to stop the immune system to destroy platelets.
Intravenous immunoglobulin, while sometimes effective, but patients do not respond, it is expensive and only temporary improvement (usually) a period less than a month. But in the case of a patient before splenectomy ITP with platelet count is dangerously low, and poor response to other treatments, IVIg therapy may increase the number of platelets, which makes the operation of splenectomy less dangerous.
Platelet transfusion is not usually recommended, and usually not successful in raising the platelet count of the patient. Since the underlying mechanisms of autoimmune diseases that destroy the patient to start destroying platelets, to the platelets from donors. An exception to this rule is if the patient is bleeding abundantly if platelet transfusion can quickly form a platelet plug to stop the bleeding.
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