Acute Immune Thrombocytopenic Purpura (ITP)

1) ITP :

Immune Thrombocytopenic Purpura (ITP) is believed to be a immunological reaction which follows an acute viral infection causing antibody binding to platelet membrane thereby allowing destruction of the antibody-coated platelets to be destroyed in reticuloendothelial system. It’s usually a clinical diagnosis with exclusion. However, those presenting with atypical features such as knee pain, inguinal mass and back pain should be investigated with bone marrow aspiration to rule out leukemia1. Platelet – associated IgG can also be tested in him and 90% of those with ITP will be tested positive1.

2) Approach in treating acute ITP :

As most of the patients of ITP achieve spontaneous remission within 8-12 weeks, it’s recommended that only those patients having platelet count of less than 20,000/mcL and significant mucous membrane bleeding or platelet count < 10,000/mcL and minor purpura be treated. He therefore fulfilled the criteria. First line of treatment would be using Prenisolone 1-2mg/kg/day until platelet count becomes normal and taper off. Prednisolone alone would be able to achieve 70% remission rate. Otherwise, intravenous gamma globulin is also effective in children usually given over 5 days or 1g/kg/day for 2 days. It’s proved to enable platelet count raise more rapidly and cost-effective than corticosteroid in acute ITP3. Platelet transfusion however is to be reserved for life threatening condition only whereas splenectomy is not indicated in the case of ITP unless severe uncontrollable haemorrhage developed. Research shows that about 22-27% of those with acute ITP will develop chronic ITP that persisted more than 6 months 4. It’s shown that active treatment do accelerate platelet count recovery however do not avert the development of chronic ITP or reduce morbidity during follow up 4. However, treatment with immunoglobulin G , intravenous Anti-D or high-dose pulse steroids have been showing promising results in delaying the need of splenectomy in chronic ITP.

Reference :
1) Jeffrey T. Kirchner Idiopathic Thrombocytopenic Purpura Diagnosis in Children
http://www.aafp.org/afp/981015ap/tips.html#12
2) Nelson Essential of Paediatrics Fifth Edition 2006 pg 714-719
3) Beck et al . Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: a systematic review and meta-analysis of randomized controlled trials. 2005 Oct;147(4):521-7.
http://www.ncbi.nlm.nih.gov/pubmed/16227040?dopt=Abstract
4) Treutiger I et al Does treatment of newly diagnosed idiopathic thrombocytopenic purpura reduce morbidity? Arch Dis Child. 2007 Aug;92(8):704-7. Epub 2007 Apr 25.
http://www.ncbi.nlm.nih.gov/pubmed/17460024?dopt=Abstract

Canthus twitching

It's been few days after that my right eyes external canthus has been twitching involuntarily.

Hmm...Not really signalling something good. I think it's giving me hint that something bad is coming.

Well, i am not sure if it's true enough. On the first day of twitching itself, my external hard disc somehow was claimed by my computer as "corrupted and unreadable"; And that was really of a "great help".

I promised TY to send over some stuff through the internet but finally didn't manage to send it as my external hard disc crashed. At that moment, it was really creating a sense of impending doom as all my data including my academic stuff that i will be needing in sem 10 are all inside and i have just got 1 copy of it

Sigh...i wasted almost 1-2 hours just to find the solution to it..Luckily, i manage to repair it using the repair procedure..Or else, all the data would have been lost into ash..

Today itself, i had my shoe torn with "Open mouth view" to become a flip-flop after V accidentally step on it. Well, i am expecting it to be worn out soon but not so soon...real sad. Guess i will have to send it to the butler shop to have it repaired. I likes that shoe as it was a comforting shoe and the only shoe which lasted me for about 2 years without needing to change one. I am considered lucky as it only got torn off at the end of the day and not the start of the day. Otherwise, i just can't imagine how will be the day like..haha