ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Physical Examinations And Laboratory Investigations In Diagnosing Idiopathic Thrombocytopenic Purpura

Updated on February 3, 2014

Lab Investigations On ITP

Source

Laboratory Investigations

Physical examination reveals the typical purpuric spots and ecchymoses, particularly over the limbs, chest and sometimes over the neck. Areas of pressure by clothing or minor trauma of rubbing as in the axillae and thighs show more purpuric spots spontaneous bleeding is seen from the mouth, nose, urinary tract and genital tract in women. In severe cases, hemorrhagic bullae develop in the mucous membrane of the mouth. The extravasated blood clots. Hematemesis and melena may occur. Ordinarily, the bleeding stops within a few days either spontaneously or with treatment. Retinal bleeding occurs in severe cases. Bleeding into the central nervous system may present as spontaneous subarachnoid hemorrhage or cerebral hemorrhages. The spleen may be just palpable in 10% of cases, in any case, there is no marked splenomegaly.

Laboratory investigations

Platelet count is reduced in all cases. It may be below 20,000 per cmm in severe cases. Under light microscopy, the platelets appear normal, except for a few large forms- the megathrombocytes. The presence of megathrombocytes indicates disordered thrombopoiesis. Though there is no gross impairment of platelet function, the antibody leads to impairment of platelet release reaction which can be demonstrated in vitro. The hemorrhagic manifestation is mainly due to thrombocytopenia, and it is aggravated by the dysfunction as well. Bleeding time is prolonged whereas the whole blood clotting time is normal. Clot retraction is deficient if the platelet count is below 50,000/cmm. Hess test is positive. Examination of the bone marrow shows increased number of megakaryocytes and many of them do not show budding activity. In over 75% of cases, antiplatelet antibodies can be demonstrated by direct or indirect tests. The degree of anemia is proportional to the blood loss.

Purpuric Lesions On A Patient

Source

Diagnosis And prognosis

Differential diagnosis

This includes allergic purpura, drug induced thrombocytopenia, systemic lupus erythematosus, acute leukemias, aplastic anemia, thrombocytopathies, vascular disorders and septicemias. Systemic lupus erythematosus may clinically present as thrombocytopenic purpura for a considerable period of time before other florid features develop. Presence of mild or moderate splenomegaly should suggest the possibility of acute leukemia, lupus erythematosus or hemolytic anemia. Sometimes ITP may be associated with other autoimmune disorders such as hemolytic anemia (Evan’s syndrome).

Course and prognosis

Acute ITP runs a short course and may remit spontaneously. It may result in serious bleeding with rapid development of anemia. Fulminant cases may be fatal if untreated. Death is due to severe blood loss or bleeding into vital organs such as the brain. Platelet counts below 10,000/cmm, hematuria, signs of meningeal irritation are grave prognostic signs. Mortality is about 3-5% in large series.

Of the acuta ITP cases, 7-28% go into the chronic form. In the chronic form periods of remissions and exacerbations alternate and the patient suffers only minor disability. Infections, menstruation, or drugs like aspirin may precipitate bleeding episodes. Menstrual and intermenstrual blood loss in women may be severe and even life-threatening and they seek medical help earlier due to this factor. During pregnancy, the bleeding episodes may aggravate in many cases, though in some cases, the condition may remit. Risk of intra-uterine death of fetus and perinatal fetal loss are high.

© 2014 Funom Theophilus Makama

Comments

    0 of 8192 characters used
    Post Comment

    No comments yet.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)