Friday, November 8, 2013


Phub Lhamo is a 44yr old lady. A known patient of idiopathic Thrombocytopenic Purpura,who presented to us on 03/07/2012with refractory thrombocytopenia , not responding to steroids. On admission she had epistaxis , occasional haematuria and petechial rashes all over her body. She was referred to Dr. Uttam Nath [haematologist] the same day. He sure 3 days of resistant(prenominal) loony toons Methylprednisone and platelet transfusion in view of progressive bleed. The adjacent day [04/07/2012] she was infused 45gm IVIg [ intravenous immunoglobulin ] and tablet azathioprine was started .This pane of glass was repeated on 08/07/2012. She was noted to have disseminated herpetic lesions for which she was apt(p) Valganciclovir.which was stopped a few(prenominal) days later for suspected operating system snapper suppression. Her haemoglobin had vanishped multiple times mainly cod to hypermenorrhea and severe malena. Periods had been suppressed with Progesterone .For malena she received Pantoprazole excerption, Tranexamic dosage infusion. For her ITP, other(a) therapies that she received [all in consultation with and as advised by Dr.
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Uttam Nath] are * ELTROMBOPAG OLAMINE tablets [from 09/07/2012] * RITUXIMAB iv once weekly [on 14/07/2012] * vincristine iv once weekly [on 17/07/2012] She was intubated and ventilate for hypovolemic impingement on 19/07/2012. She had also been presumptuousness Desmopressin nebulizer for active bleed.She also received Noradrenaline infusion. A stand up marrow aspiration study was undertaken on 13/07/2012, which showed megakaryocytic THROMBOCYTOPENIA. On 20/07/2012she became hypothermic with a drop in Hb to 5.3g/dl [one of multiple episo! des in the preceding(a) few days]. She was bring to with packed RBC concentrate ,started on noradrenaline infusion , pan-cultures sent [ to exclude septic shock ] and she was started on broad spectrum antibiotics. Hemoglobin was stablilised [21/07/2012] and noradrenaline tapered.Platelet counts improved to 90000/microl.If you essential to get a full essay, order it on our website:

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