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

Avoidable..

I had my lovely egg smashed on the floor this morning just because i am not careful enough..all the protein just splashed on the floor ..Wasted

I have started my regime of protein increasing diet by taking eggs white but not sure whether it will be working. Hopefully it will..

Anyway, about the falling egg, its just to remind me not to do something which will lead to bad stuff because i am careless. Worst when it's something which i am expecting

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

Status Does Matter

Was discussing on a matter of "clock" reading with a few of them where the conversation lead to a mess..

And, finally, it comes to a answer which i already gave. But, this time, it's from a word of distinguished person.

Status does matters isn't it? How realistic can a human being be...

so, next time, make sure you quote something from a distinguished person to validate your answer.

How irony...

Aging = Seeing More Weddings & Funeral..

Perhaps, as the days and time keep flying off ; we might not even realise that we are actually getting older and older as the time leave some track on our body.

And, i am reminded today that one of the thing which might make you realise that you are actually getting old is through SEEING MORE WEDDINGS AND FUNERALS.

True enough, as we grow up to a certain age; we might be realising that more and more of our old-time friend or relatives are getting married. Certainly, you are seeing even more funeral rituals going on in the town if you are living in a small town.

How true the statement is...as reminded. I guess i am facing it too..since long time ago when i wasn't really concern about it..

Catastrophic Rain...

Today is another day of my monthly hypnotherapy class. But, in comparison to when i was studying for my certificate and diploma, i was actually taking public transport and "Bus No 11" almost every month when i had the class.

When i was actually reaching the junction before turning into MU entrance, there start the big drops of tear from the sky and in a very short instance; it became a torrential rain which actually can wet the whole of my clothes when if i had to actually just stay in the rain for 5 seconds without cover.

I was thinking back how i was actually so fortunate the last time of being able to walk "safely" until i reached my hypnosis classroom in UM without actually having my self getting soaked.. If i were to talk and public transport for today and then walk inside UM for about 10 minutes to reach the class, i would be certainly fully soaked..haha

Fresh Fruits ...Lelong Lelong!!!

Looks very healthy isn't it with the variety of fruits available fresh from the "Pasar Malam". Guess what? It's only RM 10 for 17 mixed fruits. There are Fuji Apple, Sunkist Orange, Green Apple and etc..

Hope that i will be as healthy as how they are looking now..haha