Immune Thrombocytopenia Purpura Assignment Paper

Introduction:

Immune thrombocytopenia purpura (ITP) is a hematological condition described by a low platelet count due to the immune-mediated damage of platelets (Zitek et al., 2022). In the scenario provided, the 14-year-old female presents with abnormal bruising, red splotches, and bleeding gums, indicative of thrombocytopenia (McGuinn et al., 2022). The text aims to explore why a patient might require a splenectomy following a diagnosis of ITP and delve into the association between anemia and different types of anemia in relation to ITP, including microcytic and macrocytic anemias. Immune Thrombocytopenia Purpura Assignment Paper

Reasons for Splenectomy in ITP:

A splenectomy/surgical removal of the spleen, is a treatment option considered in cases of ITP, particularly for patients who fail to respond to initial therapies. The spleen plays a vital role in the pathophysiology of ITP. It serves as a site for the destruction of opsonized platelets by macrophages, leading to a decrease in platelet count. By removing the spleen, the primary site of platelet destruction is eliminated, resulting in increased platelet counts and reduced bleeding symptoms (Worrest et al., 2020).

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Splenectomy is typically reserved for patients with chronic or severe ITP who do not respond to first-line treatments such as corticosteroids, intravenous immunoglobulin (IVIG), or anti-D immunoglobulin. It is particularly effective in children and young adults, as their spleens are more active in platelet destruction. However, splenectomy carries inherent risks, including the potential for post-splenectomy sepsis and long-term immunological consequences, such as increased susceptibility to certain infections. Hence, it is critical to carefully weigh the benefits in addition to risks of splenectomy in each case of ITP. Immune Thrombocytopenia Purpura Assignment Paper

Anemia in ITP:

Anemia is a common complication of ITP, although it is not typically the primary manifestation of the disorder. The scenario describes a patient with normal hemoglobin (hgb) and hematocrit (hct) levels but presents with a low platelet count. However, anemia can occur secondary to chronic bleeding associated with thrombocytopenia in some cases of ITP. There are several types of anemia, each characterized by specific features such as the size and shape of red blood cells. In the context of ITP, two types of anemia are particularly relevant: microcytic and macrocytic anemias (Zitek et al., 2022).

Microcytic anemia refers to a condition where red blood cells are smaller than average. It is commonly associated with iron deficiency, which can occur due to chronic blood loss from mucosal surfaces, like the gastrointestinal tract, in patients with ITP. The presence of bleeding gums and abnormal bruising in the scenario raises concerns about potential chronic blood loss, which could contribute to microcytic anemia in this patient. On the other hand, macrocytic anemia is characterized by more giant than normal red blood cells. It can result from deficiencies in vitamin B12 or folate, which are essential for red blood cell production. Although less common in the context of ITP, macrocytic anemia may occur due to impaired absorption of these vitamins secondary to underlying gastrointestinal disorders or dietary deficiencies (Sankar & Villa, 2021). Immune Thrombocytopenia Purpura Assignment Paper

Conclusion:

In conclusion, immune thrombocytopenia purpura (ITP) presents with low platelet counts and can lead to complications such as anemia. Splenectomy may be necessary in cases of chronic or severe ITP to remove the primary site of platelet destruction and improve platelet counts. Anemia in ITP can manifest as microcytic or macrocytic, depending on the underlying mechanisms, such as chronic bleeding or nutritional deficiencies. Understanding the relationship between ITP, splenectomy, and anemia is essential for the operative managment and treatment of patients with this hematological disorder.

References

McGuinn, C., & Bussel, J. B. (2022). Disorders of platelets. In Lanzkowsky’s Manual of Pediatric Hematology and Oncology (pp. 237-285). Academic Press. https://doi.org/10.1016/B978-0-12-821671-2.00016-7

Sankar, V., & Villa, A. (2021). Hematologic Diseases. Burket’s Oral Medicine, 627-664. https://doi.org/10.1002/9781119597797.ch17

Worrest, T., Cunningham, A., Dewey, E., Deloughery, T. G., Gilbert, E., Sheppard, B. C., & Fischer, L. E. (2020). Immune thrombocytopenic purpura splenectomy in the context of new medical therapies. Journal of Surgical Research, 245, 643-648. https://doi.org/10.1016/j.jss.2019.06.092

Zitek, T., Weber, L., Pinzon, D., & Warren, N. (2022). Assessment and management of immune thrombocytopenia (ITP) in the emergency department: current perspectives. Open Access Emergency Medicine, 25-34.                                             https://doi.org/10.2147/OAEM.S331675

Zitek, Tony, Luke Weber, Dominique Pinzon, and Nicole Warren (2022). “Assessment and management of immune thrombocytopenia (ITP) in the emergency department: current perspectives.” Open Access Emergency Medicine (2022): 25-34. https://doi.org/10.1080/17512433.2021.1903315

Answer these 2 bullet points from the scenario:
Why a patient would need a splenectomy after a diagnosis of ITP.
Anemia and the different kinds of anemia relating to ITP (i.e., micro and macrocytic). Immune Thrombocytopenia Purpura Assignment Paper

Scenario 4: A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs. These bruises were first noticed about 2 weeks ago and are not related to trauma. PMH not remarkable and she takes no medications. The mother does state the girl is recovering from a “bad case of mono” and was on bedrest at home for the past 3 weeks. The girl noticed that her gums were slightly bleeding when she brushed her teeth that morning. Immune Thrombocytopenia Purpura Assignment Paper

Labs at urgent care demonstrated normal hgb and hct with normal WBC differential. Platelet count of 100,000/mm3 was the only abnormal finding. The staff also noticed that the venipuncture site oozed for a few minutes after pressure was released. The doctor at urgent care referred the patient and her mother to the ED for a complete work-up of the low platelet count, including a peripheral blood smear for suspected immune thrombocytopenia purpura. Immune Thrombocytopenia Purpura Assignment Paper