First, I wound like to say thank you for sharing and this is a CPD presentation of Medical councils especially part of public as well. I am apology you firstly if I have wronged to mention about this topic but just for development and growth together so I hope you understand! So now let’s me mention: 1. Your literature review about ITP is OK, I supported. But your case presentation is not related to your literature review. 2. ITP was diagnosed a platelet < 100,000 and can be a primary or secondary to other like SLE, HIV, Hep.C, H.pylori, or drugs-induced. For ITP patients, the Hgb is normal. This is what I want to say! 3. Related to your case review showed clinical anemia with signs of spontaneous bleeding with effect to the kidney of hematuria and the CBC revealed Low of Hgb and Platelets count. So this clinical and CBC most likely Thrombotic Thrombocytopenia Purpura (TTP). All patients with TTP have microangiopathic hemolytic anemia (MAHA) and thrombocytopenia. Other clinical features may include fever, kidney disease, and neurological abnormalities (altered mental status, headache…). => Conclusion: For your literature review is correct 👍🏻 and the case review is incorrect diagnosis of ITP but TTP. Question: why is the patient improving? Answer: In TTP was treated with Therapeutic plasma exchanged (PLEX) and Glucocorticoids are added to decrease autoantibody production that’s why this patient was improved after steroids use. Key points: - ITP: low platelets but normal Hgb (no anemia) and treatment with steroids and IV immune globulin according to clinical symptoms or asymptomatic. - TTP: low platelets + low Hgb (Anemia) + other clinical features of fever, kidney disease, and neurological abnormalities. Treatment with PLEX should be start without awaiting lab results confirming the ADAMTS13 deficiency. And you can add Steroids and Rituximab to suppress autoantibody production and decrease risk of recurrence as well. Anyway, I hope you apologize and understand about me🙏🏻 Thank you! រិះគន់ក្នុងន័យស្ថាបនា និងកែលំអរទាំងអស់គ្នាដើម្បីការរីកចម្រើនក្នុងវិស័យនេះ ព្រមទាំងអ្នកជំងឺផងដែរ។ សូមអរគុណ!
First, I wound like to say thank you for sharing and this is a CPD presentation of Medical councils especially part of public as well. I am apology you firstly if I have wronged to mention about this topic but just for development and growth together so I hope you understand! So now let’s me mention:
1. Your literature review about ITP is OK, I supported. But your case presentation is not related to your literature review.
2. ITP was diagnosed a platelet < 100,000 and can be a primary or secondary to other like SLE, HIV, Hep.C, H.pylori, or drugs-induced. For ITP patients, the Hgb is normal. This is what I want to say!
3. Related to your case review showed clinical anemia with signs of spontaneous bleeding with effect to the kidney of hematuria and the CBC revealed Low of Hgb and Platelets count. So this clinical and CBC most likely Thrombotic Thrombocytopenia Purpura (TTP). All patients with TTP have microangiopathic hemolytic anemia (MAHA) and thrombocytopenia. Other clinical features may include fever, kidney disease, and neurological abnormalities (altered mental status, headache…).
=> Conclusion: For your literature review is correct 👍🏻 and the case review is incorrect diagnosis of ITP but TTP. Question: why is the patient improving? Answer: In TTP was treated with Therapeutic plasma exchanged (PLEX) and Glucocorticoids are added to decrease autoantibody production that’s why this patient was improved after steroids use.
Key points:
- ITP: low platelets but normal Hgb (no anemia) and treatment with steroids and IV immune globulin according to clinical symptoms or asymptomatic.
- TTP: low platelets + low Hgb (Anemia) + other clinical features of fever, kidney disease, and neurological abnormalities. Treatment with PLEX should be start without awaiting lab results confirming the ADAMTS13 deficiency. And you can add Steroids and Rituximab to suppress autoantibody production and decrease risk of recurrence as well.
Anyway, I hope you apologize and understand about me🙏🏻 Thank you!
រិះគន់ក្នុងន័យស្ថាបនា និងកែលំអរទាំងអស់គ្នាដើម្បីការរីកចម្រើនក្នុងវិស័យនេះ ព្រមទាំងអ្នកជំងឺផងដែរ។ សូមអរគុណ!
thank you!