clinical meeting ITP

1. WELCOME TO CLINICAL
MEETING
Presented by
Dr. Kanta Halder
MD Phase A resident

2. Particulars of the patient :
• Name : Nusrat
• Age : 1 year 6 months
• Sex : Female
• Address : Chandpur
• Date of Admission : 03.03.15
• Date of Examination : 06.03.15
• Informant : Mother

3. Chief complaint :
• Multiple reddish and blackish spots over the
different parts of the body for 1 month.

4. History of present illness:
According to the statement of informant
mother her child was reasonably well 1
month back. Then she developed multiple
reddish and blackish spots over the different
parts of the body. The spots first appeared on left
leg, then it gradually involved front of right leg,
abdomen and chest.She also had history of per
rectal bleeding for several time 1 month back.

5. Cont..
There was no history of taking any offending
drugs, exposure to radiation, no history of
abdominal and joint pain, no urinary problem
and no other family history of similar type of
illness. With this complaints they visited a
local doctor who reffered her to DSH for
further evaluation and better management.

6. History of Past illness:
Low grade fever and cough 2 weeks prior to this
illness.
Birth history :
She was delivered by NVD at term at home
without any perinatal complication.

7. Feeding history :
He was exclusively breast fed up to 6 months,
then proper complimentary feeding was
started.
Immunization history :
As per EPI schedule.

8. Developmental history :
Age appropriate.
Treatment history:
She was treated by local doctor and took some
medication without any significant
improvement.

9. Family history:
She is the 2nd issue of non consanguineous
parents. Her elder brother and other family
members are healthy.
Socio-economic history:
They live in a pacca house ,drink boiled water
and use sanitary latrine.

10. General examination :
• Appearance : Well alert
• Pallor : Mild
• Jaundice :
• Cyanosis :
• Clubbing :
• Koilonychia : Absent
• Leukonychia :
• Oedema :
• Dehydration :

11. Cont..
• Lymph node : Not palpable
• Neck rigidity : Absent
• Bony tenderness : Absent
• Ear –Nose-Throat : Normal
• Skin survey :BCG mark present
There are multiple echymoses present over
chest and abdomen with variable size which
are non tender, non palpable and does not

12. Cont..
blanch on pressure & the largest one was
measuring about (1cm × 2cm).

13. Vital sign :
• Temperature : 99ºF
• BP : 80/50 mmHg
• Pulse : 100b/ min
• Respiratory rate : 26 /min

14. Anthropometry
• Weight : 9.2 kg
• Height : 75 cm
• WAZ : 3rd centile
• HAZ : 5th centile
• WHZ : 25th centile

15. Systemic Examination
Haemopoetic System :
• Mouth and oral cavity : Normal
• Anemia : Mild
• Jaundice : Absent
• Bony Tenderness : Absent.
• Lymph nodes : Not palpable

16. Cont..
• Skin Survey: There are multiple echymotic
areas on different parts of body as mentioned
earlier.
• Abdomen: No organomgaly
• Other systemic examination including
locomotor system reveals normal finding.

17. Salient feature:
Nusrat, a 1year 6 months oldgirl, 2nd issue of
her parents, fully immunized, got admitted
with the complaints of multiple echymoses of
variable size over the different parts of the
body for 1 month and history of per rectal
bleeding for several time 1month back. She
also had history of low grade fever and cough
2 weeks prior to this illness. There was no
history of taking any offending drugs, radiation

18. Cont..
exposure, no abdominal or joint pain,no
urinary problem and no similar type of illness
in the family. On examination Nusrat was well
alert, afebrile, mildly pale, vital signs were
within normal limit. There were multiple
echymoses of variable size,which were non
tender, not palpable and did not blanch on
pressure. Other systemic examination revealed
no abnormality.

19. Provisional diagnosis:
Immune thrombocytopenic purpura.

20. Differential diagnosis:
 Henoch Schonlein Purpura

21. Investigations :
Complete Blood Count :
• Hb% : 10.5 gm/dl
• TC of WBC : 11,500/cumm.
• DC of WBC : Neutrophil 56%
Lymphocyte 40%
Monocyte 2 %
Eosinophil 2%
• Platelet : 20,000/cumm

22. Cont..
Peripheral blood film :
• RBC : Anisochromic anisocytosis
• WBC : mature with normal distribution
• Platelets : reduced
Comment :Thrombocytopenia

23. Final diagnosis :
Immune thrombocytopenic purpura (ITP).

24. TREATMENT :
Supportive:
• Education and Counseling
• Adequate nutrition
Specific:
• Steroid therapy : Tab. Prednisolone 2mg/kg/day
Follow up

25. Thank You