NEW PPT1

Case presentation on IDIOPATHIC THROMBOCYTOPENIA: 

Case presentation on IDIOPATHIC THROMBOCYTOPENIA By Ms.Supriya.Prajapati Ist year PBBSC Student

PATIENT’S BIODATA: 

PATIENT’S BIODATA NAME – Vedant Shashikant Temghare. AGE/SEX- 11yrs/ mch PROVISIONAL DIAGNOSIS- Idiopathic thrombocytopenia.

OUTLINE: 

OUTLINE Idiopathic Thrombocytopenic Purpura is now termed as IMMUNE(autoimmune)THROMBOCYTOPENIC PURPURA It is one of the most common bleeding disorder resulting from immune destruction of platelets by antiplatelet antibodies.

ETIOLOGY: 

ETIOLOGY Viral infections such as measles, chickenpox etc. Immune factor i.e. antiplatelet antibodies causing destruction of platelets. Increased destruction of platelets by the reticuloendothelial system in the spleen. Genetic factors(not proved).

PATHOGENESIS: 

PATHOGENESIS

CLINICAL MANIFESTATIONS: 

CLINICAL MANIFESTATIONS Mainly affects children between 2 -10 yrs of age. Boys & girls are equally affected. History of infection mainly upper respiratory tract infections. Also chickenpox,measles,mumps,rubella are often associated. Sudden onset of purpura or petechiae may be found all over the body.

CLINICAL MANIFESTATIONS: 

CLINICAL MANIFESTATIONS Some may be accompanied by bleeding from gums,lips,nosebleeds (epistaxis). Anaemia may be seen in severe haemorrhage. Spleen may be palpable in 1/4 th cases. Severe manifestations may be found as haematuria,GI bleeding,intracranial haemorrhages etc.

PATIENT PICTURE: 

PATIENT PICTURE Fever . Easy bruising following minor trauma. Petechiae and bleeding. Ecchymosis on anterior surface of lower limbs and over bony prominence.

CLASSIFICATION OF ITP: 

CLASSIFICATION OF ITP According to the course of the disease, ITP is classified into two types Acute ITP (aITP):It is more common in childhood,usually following viral infections. Chronic ITP (cITP):It is less common in children,no history of viral infection is detected.

DIFFERENCE BETWEEN: 

DIFFERENCE BETWEEN Acute ITP(aITP) AGE – peak incidence b/w 2 and 5 yrs of age. ONSET- relatively acute. DEGREE OF HAEMORRHAGE- severe Chronic ITP(cITP) AGE- more frequent in adolescents and young age adults. ONSET-relatively chronic. DEGREE OF HAEMORRHAGE- mild.

DIFFERENCE BETWEEN (Contd…): 

DIFFERENCE BETWEEN (Contd…) Acute ITP(aITP) PLT COUNT- mostly,<20×10⁹/L. COURSE OF DISEASE- ≤ 6 months. NO. OF MEGAKARYOCYTES- normal or increased. Chronic ITP(cITP) PLT COUNT- commonly(30~80)×10⁹/L. COURSE OF DISEASE- >6months. NO. OF MEGAKARYOCYTES- increased markedly.

LABORATORY STUDIES: 

LABORATORY STUDIES Careful history regarding previous infections,drug therapy should be obtained. Thorough clinical examination should be done. Tourniquet test or Hess test shows positive findings.

LABORATORY STUDIES: 

LABORATORY STUDIES BLOOD EXAMINATION Reduced platelet count. Lymphocytosis and eosinophilia may be present. White blood cells and morphology are normal Haemoglobin values are normal unless there has been prolonged bleeding. Bone marrow study reveals increased number of megakaryocytes. Platelet antibody assay helps to confirm the diagnosis.

MEDICAL MANAGEMENT: 

MEDICAL MANAGEMENT Supportive management to be provided with blood and platelet transfusion to prevent bleeding and treat bleeding episodes. Corticosteroid therapy is given in high dose to inhibit platelet antibody production, interaction between platelet and antibodies, prolong platelet survival and improve vascular stability. Prednisolone 1 to 2 mg/kg/day for 2 to 3 weeks followed by tapering doses over next 1 to 2 weeks is given.

MEDICAL MANAGEMENT: 

MEDICAL MANAGEMENT Intravenous immunoglobulin (IV- IgG) is administered with 2gm/kg of total dose to protect platelet antibody Anti-Rh therapy can be used effectively to control the acute bleeding episodes or to increase platelet count before surgery.

MEDICAL MANAGEMENT: 

MEDICAL MANAGEMENT Splenectomy is indicated for the patients not responding to steroids and IV- IgG therapy. About 10 to 15 percent cases of ITP require splenectomy. Refractory cases of ITP can be treated with immunosuppressive drugs like vincristine,azathioprine, cyclophosphamide,etc. Newer treatment modalities like interferon,plasmaphoresis have been found effective for these cases.

NURSING DIAGNOSIS: 

NURSING DIAGNOSIS Altered body temperature (hyperthermia) related to disease condition (platelet 20000/cu.mm) as evidenced by vital signs checked(Temp-101°f). Altered nutritional pattern related to low intake as verbalized by pt’s mother. Anxiety related to disease and treatment therapy as evidenced by pt’s questionnaires. Potential risk for infection related to immunosupression caused by corticosteroid therapy. Potential risk for bleeding related to alteration in blood parameters (platelet 20000/cu.mm).

NURSING MANAGEMENT: 

NURSING MANAGEMENT Assessment of pt’s condition by detail history, physical examination, arranging diagnostic tests and reviewing the findings. Monitoring child’s vital signs,intake-output,stool for occult blood, menstrual bleeding flow etc. Taking precautions during blood or blood product transfusion to prevent anaphylaxis, volume overload and infection. Prevent constipation by dietary modifications.

NURSING MANAGEMENT: 

NURSING MANAGEMENT Restricting activity and exercise to prevent accidental injury. Minimizing bleeding by special precautions during care. Avoid IM injections, use of tourniquets, trauma, and rectal procedures. Instructing parents and child for avoidance of nose blowing, nose pricking, hard tooth brush, use of aspirin, NSAIDs, trauma etc. Teach parents about home based care specially during bleeding, need for medical help and follow up at regular interval.

PowerPoint Presentation: 

THANK YOU