Vital Signs: A Case Study
A 4-year-old girl is brought into a physician’s office by her mother because the mother noticed a rash that started to appear on her daughter’s legs about 2 months ago. The rash is not painful or itchy and does not seem to be resolving. The patient is up-to-date on her immunizations and has no other medical problems besides the usual colds, the last one occurring about 3 months ago. She shares a bed with her older sister but is the only one in the family with the rash. Vital signs are within normal limits, and physical examination shows a healthy-looking child who is in no acute distress. The rash consists of pinpoint, round spots in clusters that are non-palpable and are found on her legs and abdomen. The rash’s appearance is shown.
Her …show more content…
Indications for pharmacologic intervention in children with ITP include any child with severe or life-threatening bleeding, children with a platelet count < 10,000/μL and signs of substantial cutaneous bleeding (bruising, bleeding, petechiae), children with a platelet count of < 30,000/μL and signs of moderate bleeding (mucosal bleeding, epistaxis, hematuria), and new or unexplained headache or neurological change in those with a very low platelet count (< 20,000/μL) or after head trauma. Treatment options include intravenous immune globulin (IVIG), intravenous anti-D immune globulin (anti-D), or glucocorticoids. Because this child does not demonstrate any bleeding, observation would be the best next step in …show more content…
Immediate plasmapheresis would be the appropriate answer if this child was suffering from thrombotic thrombocytopenic purpura (TTP), which is characterized by clotting in the small blood vessels that lead to thrombocytopenia. The classic pentad of full-blown TTP includes fever, anemia, thrombocytopenia, acute renal failure, and neurological impairment (altered mental status, seizures, hemiplegia, paresthesias, etc.). Laboratory values show normal coagulation studies along with a low fibrinogen level. This child does not present with any of these symptoms, so plasmapheresis would be
Her …show more content…
Indications for pharmacologic intervention in children with ITP include any child with severe or life-threatening bleeding, children with a platelet count < 10,000/μL and signs of substantial cutaneous bleeding (bruising, bleeding, petechiae), children with a platelet count of < 30,000/μL and signs of moderate bleeding (mucosal bleeding, epistaxis, hematuria), and new or unexplained headache or neurological change in those with a very low platelet count (< 20,000/μL) or after head trauma. Treatment options include intravenous immune globulin (IVIG), intravenous anti-D immune globulin (anti-D), or glucocorticoids. Because this child does not demonstrate any bleeding, observation would be the best next step in …show more content…
Immediate plasmapheresis would be the appropriate answer if this child was suffering from thrombotic thrombocytopenic purpura (TTP), which is characterized by clotting in the small blood vessels that lead to thrombocytopenia. The classic pentad of full-blown TTP includes fever, anemia, thrombocytopenia, acute renal failure, and neurological impairment (altered mental status, seizures, hemiplegia, paresthesias, etc.). Laboratory values show normal coagulation studies along with a low fibrinogen level. This child does not present with any of these symptoms, so plasmapheresis would be