22 yr young girl presented with severe thrombocytopenia of one month duration with platelet counts of 5000 to 10000, other blood parameters including serology are normal (ANA is positive, ds DNA report is due), not responding to pulse therapy of Methyl prednisolone follwed by oral prednisolone with almost > 15 units of platelet transfusions. She is having oral mucosal bleeding and skin purpura.....Any suggestion?
HP was described associated to chronic ITP quite often in Italian and Asian medical litterature (40 to 60 %), usely they are older ITP than your patient (50 y old or more). these high rates of prevaence have not confirmed in Northern countries. I think it 's worth screening Hp in chronic ITP, older patients or any of those with gastric symptoms.
on the other hand, HP eradication improves only approximately 50 % of the patient with partial remission.
more recently, virulence profile of HP may be involved:
Giovanni et al. December 1, 2007; Blood: 110 (12)
It is quite frequent!
In our local experience, it is present around 50% of all cases.
Also in old cases, esplenectomized, years later it has been diagnosed, erradicated, and the basal platelet level has improved!
The digestive european guidelines give a 1A level of evidence
It would be appropriate to control the immune system (antiplatelet antibodies and complement), the quality of platelets (platelet surface receptors (Cd2b and CD41a) and tournover platelets (reticulated platelets). It would be good to know if the girl has suffered viral infection, did use of estrogens or other drugs. Finally, if everything is negative I would place the problem of a paraneoplastic microangiopathy, ricercherei tumor markers and, in the absence of blood tests already carried out, but the negative (due to cortisone), the TC have subjected to examination of the skull.
Thanx all for valuable suggestion....patient's clinical status is almost same, no further deterioration, but one report is confusing..her fT3,fT4 and TSH all are low, Cortisone, FSH, LH are normal....ds DNA is negative..there was no h/o viral infection and no suggestive drugs history....we are planning for MRI Pituitary...
By h pylori eradication we may avoid splenectomy in chronic ITP patients
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