Paediatric-History taking & Physical examination of a patient with Idiopathic Thrombocytopenic Purpura (ITP)

Paediatric-History taking & Physical examination of a patient with Idiopathic Thrombocytopenic Purpura (ITP)Created OnApril 28, 2020Last Updated OnApril 28, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of a patient with Idiopathic Thrombocytopenic Purpura (ITP) < All Topics Table of Contents History taking: Commonly asymptomatic Typically presents with the sudden appearance of a petechial rash, bruising or bleeding in an otherwise healthy child. Acute onset of bleeding symptoms depend on platelet counts Easy bruising, petechiae, bleeding, hematuria, melena It ranges from minimal mucocutaneous bleeding to severe and life-threatening intracranial haemorrhage, severe gastrointestinal or genitourinary bleeding. Cutaneous (petechiae, purpura, or bruising) – 86% Oral – 19% Nasal – 20% No bleeding – 9% Menstrual, gastrointestinal, or urinary bleeding – <3 % GI bleeding or other severe mucosal bleeding requiring blood products – <3% Intracranial haemorrhage (ICH) – Rare, 0.5% ICH in ITP almost always occurs in supratentorial Enquires about the risk factors – severe thrombocytopenia of <10,000, previous wet purpura bleeding, head trauma and exposure to antiplatelet medications. Duration from onset of thrombocytopenia to normalisation of platelet counts can be a few days to 6 months (average 3 weeks). Acute ITP usually preceded by viral infection Preceding illness or vaccination— 60% of children with newly diagnosed ITP have a preceding viral illness within the past month MMR vaccine has a very small increased risk of ITP. About 2.6 cases/100,000 doses of vaccine. Systemic symptoms fever, anorexia, bone or joint pain, weight loss, gastrointestinal symptoms, headache exposure to thrombocytopenia-inducing drugs Ask about past medical history – Prior history of bleeding Ask about family history of bleeding Physical examination: General examination Well-being of patient – ITP patients usually appears to be healthy Vital signs – look for Cushing reflex with hypertension and bradycardia which may be caused by life threatening intracranial haemorrhage Evidence for infection Skin and mucosal membrane Describe the distribution, size and...

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