IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP)

CASE ANALYSIS PRESENTATION

Sarah G. Lopez Clinical Pharmacy Laboratory

Patient Information
LR, an 18 year old F was diagnosed with ITP. The only indication present up until now are bruises, red to violet spots in the skin, menorrhagia and rarely bleeding gums. As a child the said signs appeared but the condition was only diagnosed in her high school years. There are no significant PMH, SH and FH present. She had NKA.
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Patient is currently taking prednisone 15mg tablet PO BID (Available dose 30mg, broken half), Vitamin C 500mg PO TID after meals, Fersulfate 500mg PO as needed during menstruation period. Herbal Supplements, Complete Phyto Energizer 500mg PO BID, Power C plus 500mg PO BID 2xper meal and Power greens 500mg PO BID 2x per meal.
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General PE; well developed, VS; BP, temp. and RR normal, weight 50kg, height 142cm. Extremities; petechia and purpura present when PLT is low. Gets easily bruised. Blood testing, PLT count, Bone marrow testing and X-ray was 9 done. Lowest PLT count recorded was 7x10 .

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Bone marrow testing showed normal results and she has no other blood related condition. It was done to rule out other conditions that manifest thrombocytopenia. X-ray is done to monitor the effects of prednisone in bones.

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Platelets

Produced in blood cell formation in bone marrow They circulate in the blood of mammals and are involved in homeostatis, leading to the formation of blood clots. Low levels can lead to excessive bleeding, high levels leads to blood clots (thrombosis) 3 Normal level 150000-400000 mm is Life span is 5 to 10 days Platelets are destroyed by phagocytosis in the spleen
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Discussion of Disease State

Idiopathic Thrombocytopenic Purpura (ITP) is an acquired hemorrhagic disorder characterized by: Thrombocytopenia - excessive destruction of platelets Purpura - a discoloration caused by petechiae beneath the skin Normal bone marrow with normal or increased number of immature platelets(megakaryocytes) and eosinophils
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Although the cause is unknown, it is believed to be an autoimmune response to disease-related antigens. It is the most frequently occurring thrombocytopenia of childhood. The greatest frequency of occurrence is between 0 and 10 years of age. The disease occurs in one of two forms: an acute, self limiting course or a chronic condition (greater than 6 months duration).
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Clinical Manifestation

Easy Bruising(purpura); Petechiae Ecchymoses, most often over bony prominences Bleeding from mucous membrane Epistaxis Bleeding gums Internal hemorrhage: hematuria, hematemesis, melena hemarthrosis, menorrhagia
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Purpura and

Diagnostic Evaluation
In ITP, the PLT count is reduced to below 20,000 3 mm ; therefore, tests that depend on PLT function such as bleeding time, and clot retraction are abnormal. Although there is no denite test on which to establish a diagnosis of ITP, several are usually performed to rule out other disorders in which thrombocytopenia is a manifestation, such as systemic lupus erythematosus, lymphoma or leukemia.
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Discussion of Drug Therapy

Prednisone

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Project Description

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Procedure/Methodology

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Key Findings/Results 1
100 90 80 70 60 50 40 30 20 10 First Second Third

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Test 1 Test 2 Test 3 Test 4

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Key Findings/Result 2
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Key Findings/Result 3
Run Number 1 2 3 Description Condition A Condition B Condition C Result A True True False Result B True False False

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Case Presentation by S.Lopez