What are the clinical manifestations of idiopathic thrombocytopenic purpura?

Idiopathic thrombocytopenic purpura is the most common bleeding disorder in children, characterized by spontaneous bleeding, and most children have a history of viral infection about 3 weeks before the onset of the disease.

Clinical presentation. The disease occurs in children of all ages and is divided into two categories: acute and chronic. Acute idiopathic thrombocytopenic purpura is mostly found in childhood, and it is more common in infancy and early childhood, with a higher incidence in spring, no history of bleeding in the past, sudden onset, severe bleeding, and infection shortly before or at the same time of bleeding.

Chronic cases are more common in the preschool and school-age periods, and most of them have an insidious onset and mild bleeding symptoms.

Thrombocytopenic purpura hemorrhage is characterized by extensive mucosal bleeding, mostly scattered intradermal or subcutaneous hemorrhage points the size of a pinhead, and more extremities; However, it may also be generalized hemorrhagic plaque or hematoma; Some patients have profuse epistaxis or bleeding gums as the main symptom. Intracranial hemorrhage occurs in about 1 patients, which is the leading cause of death in idiopathic thrombocytopenic purpura. Patients with severe bleeding may have hemorrhagic anemia and, occasionally, hemorrhagic shock.

Intracranial hemorrhage manifests as headache, drowsiness, coma, convulsions, paralysis and other symptoms.

Course of disease and prognosis.

Although the bleeding in acute patients is severe, it can heal spontaneously without special **. Generally, the bleeding is severe in the first week of onset, the bleeding decreases or no longer occurs in the second week, and it disappears completely without bleeding in the second or third week, but the platelet count rises more slowly. About 90 patients can be cured within 1 year.

There are also some cases that can become chronic.

In chronic patients, the course of the disease lasts from several months to more than ten years, and the blood can be reversed, which is not healed, and the platelets often fluctuate between 230,000 and 780,000. Sometimes bleeding that is difficult to control occurs.

Prevention and control measures. Generally**acute cases are mainly due to severe bleeding within 1 to 2 weeks of onset, so in the early stage of the disease, the child should be given bed rest, reduce activities, avoid trauma, actively control infection, give sufficient fluids and easily digestible diet, a large amount of vitamin C and P, and local hemostasis. A smaller dose of prednisone 1 2 mg per day can also be taken orally, and the use can be gradually discontinued when bleeding improves.

Chronic thrombocytopenic purpura does not require severe bleeding or remission**, but care should be taken to avoid trauma and prevent infection, especially respiratory tract infection. For patients with severe bleeding or those who have not been cured for a long time, the following special ** should be performed.

Whole blood or platelet transfusion is indicated for patients with acute massive bleeding, and for patients with high hemoglobin, platelet or platelet-rich plasma can be transfused.

For children with critically ill adrenocorticosteroid hemorrhage, hydrocortisone 10 20 mg kg a day should be given intravenously infusion in 2 to 3 times, and oral prednisone should be changed after the symptoms improve. For patients with more severe bleeding, prednisone 2 mg kg orally daily can be started initially. In acute patients, the dose can be reduced when the bleeding phenomenon disappears, and the drug should be discontinued within 3 to 4 weeks.

Chronic patients often need to take a full dose of medication for 3 weeks, and when the bleeding stops, the platelets rise to more than 50,000 cubic millimeters, and the dose is gradually reduced.

Other drug immunosuppressants, such as vincristine, azathioprine, 6MP, cyclophosphamide, etc.

Idiopathic thrombocytopenic purpura, generally with a more insidious onset, is manifested as scattered bleeding points and other minor bleeding symptoms, such as epistaxis, gingival bleeding, and purpura and ecchymosis can appear in any part of the ** and mucous membranes, but mainly common in the lower limbs and distal upper limbs.

Idiopathic thrombocytopenia is an acquired bleeding disorder of unknown cause, characterized by thrombocytopenia, normal or increased megakaryocytes in the bone marrow, and absence of any cause. Also known as autoimmune thrombocytopenic purpura, clinical symptoms are scattered in ** bleeding spots, purpura, ecchymosis, epistaxis, gingival bleeding, etc. Idiopathic thrombocytopenic purpura not only causes ** damage, but also causes intracranial hemorrhage and even death in severe cases.

The incidence is higher in females of childbearing age than in males. Glucocorticoids, intravenous gamma globulin, etc.**, and splenectomy if necessary.

<> generally has an insidious onset, manifested as scattered ** bleeding points and other mild bleeding symptoms, such as epistaxis, gingival bleeding, etc. Purpura and ecchymosis can occur anywhere** or mucous membranes, but are common in the lower and distal upper extremities. The hemorrhagic manifestations of ITP patients are related to the platelet count to a certain extent, and the platelet count can be caused by mild trauma between (20 50) 109 L, and a few are spontaneous hemorrhage, such as ecchymosis, petechiae, etc., the platelet count is less than 20 109 L, there is a risk of severe bleeding, and the platelet count is less than 10 109 L, intracranial hemorrhage may occur.

Examination is usually spalenomegaly, but a few patients may have mild splenomegaly, possibly due to a viral infection. Children with acute ITP may have a history of respiratory tract infection 1 to 3 weeks before the onset of the disease, and rarely after vaccination.

The onset is acute, and a few manifestations are explosive onset, with mild fever, chills, and sudden occurrence of extensive and severe ** mucosal purpura, and even large ecchymosis. **The petechiae are mostly generalized, and the lower limbs are mostly evenly distributed. Mucosal bleeding is more common in the nasal cavity, gums, and stomatology has blood blisters.

Gastrointestinal and urinary tract bleeding is not uncommon, and less than 1% of children experience life-threatening intracranial hemorrhage. If the patient has headache or vomiting, he or she should be alert to the possibility of intracranial hemorrhage. Most patients resolve spontaneously, and a few become chronic if they do not heal.

Answer]: A Idiopathic thrombocytopenic purpura is an autoimmune disease, mainly due to the binding of autoantibodies to platelets, resulting in shortened platelet survival and leading to bleeding. The clinical characteristics of Henoch-Schonlein purpura (articular type) are the swelling and pain of the knee, ankle, elbow and wrist joints before and after the appearance of **purpura, with the pain and swelling of the knee joint being the most significant, which can be in a migratory state and reversed.

Therefore, 17 questions are selected B, and 18 questions are selected A.

Answer]: A1Aplastic anemia is manifested as pancytopenia, with a significant decrease in reticulocytes and an increased percentage and lymphocyte ratio.

Idiopathic thrombocytopenic purpura often presents as: decreased platelet count; The mean platelet volume is large; prolongation between the osmotic hoods during bleeding; Poor contraction of blood clots. Platelet function is usually normal early.

Answer] :d idiopathic thrombocytopenic purpura is caused by the presence of platelet culture lead and antibodies in the peripheral blood, resulting in thrombocytopenia; hemoglobin abrasion may be normal or reduced; The white blood cell count is usually normal.