MyMedR

Persistent thrombocytopenia following dengue fever: What should we do?

Boo YL, Lim SY, P'ng HS, Liam C, Huan NC

Malays Fam Physician, 2019;14(3):71-73.

Thrombocytopenia is a common laboratory finding in dengue infection. However, it usually resolves as the patient recovers from the infection. Persistent thrombocytopenia following dengue infection requires further investigation. Here, we present a case of immune thrombocytopenic purpura (ITP) following dengue infection complicated by intracranial bleeding.

Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic

Outcome of immunosuppression in children with IgA vasculitis-related nephritis

Rohner K, Marlais M, Ahn YH, Ali A, Alsharief A, Novak AB, et al.

Nephrol Dial Transplant, 2024 Jul 31;39(8):1299-1309.

PMID: 38211969 DOI: 10.1093/ndt/gfae009

BACKGROUND: Immunoglobulin A vasculitis with nephritis (IgAVN) is the most common vasculitis in children. Due to a lack of evidence, treatment recommendations are based on expert opinion, resulting in variation. The aim of this study was to describe the clinical presentation, treatment and outcome of an extremely large cohort of children with biopsy-proven IgAVN in order to identify prognostic risk factors and signals of treatment efficacy.

METHODS: Retrospective data were collected on 1148 children with biopsy-proven IgAVN between 2005 and 2019 from 41 international paediatric nephrology centres across 25 countries and analysed using multivariate analysis. The primary outcome was estimated glomerular filtration rate (eGFR) and persistent proteinuria at last follow-up.

RESULTS: The median follow-up was 3.7 years (interquartile range 2-6.2). At last follow-up, 29% of patients had an eGFR <90 mL/min/1.73 m2, 36% had proteinuria and 3% had chronic kidney disease stage 4-5. Older age, lower eGFR at onset, hypertension and histological features of tubular atrophy and segmental sclerosis were predictors of poor outcome. There was no evidence to support any specific second-line immunosuppressive regimen being superior to others, even when further analysing subgroups of children with reduced kidney function, nephrotic syndrome or hypoalbuminemia at onset. Delayed start of immunosuppressive treatment was associated with a lower eGFR at last follow-up.

CONCLUSION: In this large retrospective cohort, key features associated with disease outcome are highlighted. Importantly, there was no evidence to support that any specific immunosuppressive treatments were superior to others. Further discovery science and well-conducted clinical trials are needed to define accurate treatment and improve outcomes of IgAVN.

Matched MeSH terms: Purpura, Schoenlein-Henoch/complications; Purpura, Schoenlein-Henoch/diagnosis; Purpura, Schoenlein-Henoch/drug therapy

Fulltext Corticosteroid-responsive prolonged thrombocytopenia following dengue haemorrhagic fever

Leong KW, Srinivas P

Med J Malaysia, 1993 Sep;48(3):369-72.

PMID: 8183156

A case of prolonged thrombocytopenia following dengue haemorrhagic fever in a 15 year old boy is reported. The mechanism was presumed to be immunological and he responded dramatically to oral prednisolone.

Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/drug therapy; Purpura, Thrombocytopenic, Idiopathic/etiology*

Hypertension in the absence of urinary abnormalities - An unusual presentation of anaphylactoid purpura

Thong PL, How KN, Bakrin IH

Med J Malaysia, 2020 07;75(4):436-438.

PMID: 32724011

Henoch-Schonlein Purpura (HSP) or anaphylactoid purpura, currently named IgA vasculitis is the most common form of systemic vasculitis in children. In adults and young infants, HSP tends to have atypical presentations with higher rates of severe gastrointestinal problems and delayed renal complications. While hypertension is a known complication of HSP nephritis, it is rarely seen in individuals with normal renal function and urinary findings. We report a case of a 7-year-old boy with HSP, who presented with abdominal pain and severe hypertension without other features of glomerulonephritis.

Matched MeSH terms: Purpura, Schoenlein-Henoch/diagnosis*; Purpura, Schoenlein-Henoch/physiopathology*

User-driven health care - answering multidimensional information needs in individual patients utilizing post-EBM approaches: a conceptual model

Biswas R, Martin CM, Sturmberg J, Shanker R, Umakanth S, Shanker S, et al.

J Eval Clin Pract, 2008 Oct;14(5):742-9.

PMID: 19018905 DOI: 10.1111/j.1365-2753.2008.00998.x

Evidence based on average patient data, which occupies most of our present day information databases, does not fulfil the needs of individual patient-centred health care. In spite of the unprecedented expansion in medical information we still do not have the types of information required to allow us to tailor optimal care for a given individual patient. As our current information is chiefly provided in disconnected silos, we need an information system that can seamlessly integrate different types of information to meet diverse user group needs. Groups of certain individual medical learners namely patients, medical students and health professionals share the patient's need to increasingly interact with and seek knowledge and solutions offered by others (individual medical learners) who have the lived experiences that they would benefit to access and learn from. A web-based user-driven learning solution may be a stepping-stone to address the present problem of information oversupply in medicine that mostly remains underutilized, as it doesn't meet the needs of the individual patient and health professional user. The key to its success would be to relax central control and make local trust and strategic health workers feel more engaged in the project such that it is truly user-driven.

Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/diagnosis; Purpura, Thrombocytopenic, Idiopathic/psychology; Purpura, Thrombocytopenic, Idiopathic/therapy

Fulltext Spontaneous intracranial haemorrhage in children with chronic immune thrombocytopenic purpura

Muda Z, Ibrahim H, Abdulrahman EJ, Mahfuzah M, Othman IS, Asohan T, et al.

Med J Malaysia, 2014 Dec;69(6):288-90.

PMID: 25934964 MyJurnal

Spontaneous intracranial haemorrhage (ICH) is a rare complication of chronic immune thrombocytopenic purpura (ITP) in children. We report four patients with cITP who developed ICH. The latency between onset of ITP and ICH varied from 1-8 years. All our patients were profoundly thrombocytopenic (platelet count of <10 x 109/l) at the time of their intracranial bleed. The presenting features and management are discussed. All patients survived, three had complete neurological recovery while one had a minimal residual neurological deficit.

Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic

Fulltext A comparison of thrombotic thrombocytopenic purpura in an inception cohort of patients with and without systemic lupus erythematosus

Letchumanan P, Ng HJ, Lee LH, Thumboo J

Rheumatology (Oxford), 2009 Apr;48(4):399-403.

PMID: 19202160 DOI: 10.1093/rheumatology/ken510

To compare the clinical presentation, response to therapy and outcome of thrombotic thrombocytopenic purpura (TTP) in an inception cohort of patients with and without SLE.

Matched MeSH terms: Purpura, Thrombotic Thrombocytopenic/complications*; Purpura, Thrombotic Thrombocytopenic/mortality; Purpura, Thrombotic Thrombocytopenic/therapy

Essential thrombocytopenia

Haridas G

Journal of the Malaya Branch of the British Medical Association, 1940;4:198-204.

Matched MeSH terms: Purpura, Thrombocytopenic

Fulltext Purpura Fulminans: A rare presentation of Streptococcus Pneumoniae infection

Teo HG, Wong JY, Ting TLL

BMJ Case Rep, 2017 Oct 20;2017.

PMID: 29054893 DOI: 10.1136/bcr-2017-221150

A previously healthy man presented with fever for 2 days and rapidly progressive purpuric rash for 1 day. He progressed into hypotension, disseminated intravascular coagulation and refractory shock despite resuscitation and early antibiotic commencement. Blood culture grew Streptococcus pneumoniae This case report highlights the fact that purpura fulminans can be a rare presentation of S. pneumoniae infection as well.

Matched MeSH terms: Purpura Fulminans/complications; Purpura Fulminans/microbiology*; Purpura Fulminans/therapy

Extragastrointestinal manifestations of Helicobacter pylori infection: facts or myth? A critical review

Tan HJ, Goh KL

J Dig Dis, 2012 Jul;13(7):342-9.

PMID: 22713083 DOI: 10.1111/j.1751-2980.2012.00599.x

Helicobacter pylori (H. pylori) infection is reported to be associated with many extragastrointestinal manifestations, such as hematological diseases [idiopathic thrombocytopenic purpura (ITP) and unexplained iron deficiency anemia (IDA)], cardiovascular diseases (ischemic heart diseases), neurological disorders (stroke, Parkinson's disease, Alzheimer's disease), obesity and skin disorders. Among these, the best evidence so far is in ITP and unexplained IDA, with high-quality studies showing the improvement of IDA and ITP after H. pylori eradication. The evidence of its association with coronary artery disease is weak and many of the results may be erroneous. The role of H. pylori infection in affecting serum leptin and ghrelin levels has attracted a lot of attention recently and available data to date have been conflicting. There have also been many uncontrolled, small sample studies suggesting an association between H. pylori infection and neurological disorders or chronic urticaria. However, more studies are required to clarify such proposed causal links.

Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/microbiology

Method optimization on the use of postocclusive hyperemia model to assess microvascular function

Yvonne-Tee GB, Rasool AH, Halim AS, Wong AR, Rahman AR

Clin. Hemorheol. Microcirc., 2008;38(2):119-33.

PMID: 18198413

Recent development had allowed non-invasive assessment of microvascular function in vivo; however, the method has not been fully optimized and standardized. In this study, we aimed to characterize the "effective" occlusion duration needed to elicit sufficient postocclusive hyperemia (PORH) responses in forearm skin using laser Doppler fluximetry (LDF), in subjects with differing age, gender and menstrual phases.

Matched MeSH terms: Purpura/etiology

Fulltext Adult idiopathic thrombocytopenic purpura without the option of splenectomy

Jackson N, Mustapha M, Baba AA

Med J Malaysia, 1995 Sep;50(3):250-5.

PMID: 8926904

In this part of Malaysia, consent of splenectomy is virtually unobtainable, so we studied the outcome of ITP without this treatment option. Thirty-two adult patients were seen, but 7 defaulted before therapy evaluation. Of the remaining 25, 17 achieved a complete remission with prednisolone, but in only 8 was this prolonged. Twelve patients, who failed to respond to prednisolone or who required > 15 mg/day as maintenance, were offered splenectomy, but all fused. Of these 12: one has died from an intracranial haemorrhage; three others have defaulted while on no treatment with platelet counts of < 16 x 10(9)/1; one has had a baby who died from intracranial bleeding. The other seven patients have platelet counts ranging from 4 - 202 x 10(9)/1 with moderate bleeding on doses of prednisolone of 0-60 mg/day: long-term corticosteroid side-effect are evident in all but one of them. This study demonstrates that ITP patients who refuse splenectomy have a high morbidity.

Matched MeSH terms: Purpura, Thrombocytopenic/drug therapy*

Unlicensed medical practice in West Malaysia

Chen PC

Trop Geogr Med, 1971 Jun;23(2):173-82.

PMID: 4327992

Matched MeSH terms: Purpura, Thrombocytopenic/complications

Life-threatening complications of Henoch-Schönlein purpura: diffuse alveolar haemorrhage, venous thrombosis and bowel ischaemia

Dhaliwal KK, Lile NA, Tan CL, Lim CH

BMJ Case Rep, 2020 Sep 29;13(9).

PMID: 32994270 DOI: 10.1136/bcr-2020-235905

Henoch-Schönlein purpura (HSP) is a common systemic vasculitis occurring in children. Making a diagnosis of HSP is often straightforward, managing its complications can be difficult. Diffuse alveolar haemorrhage (DAH), bowel ischaemia and venous thrombosis are rare complications of this disorder. We present a case of a 15-year-old teenage girl presenting with typical purpuric rash of HSP, developed DAH, bowel ischaemia and venous thrombosis. She was successfully treated with pulse methylprednisolone, intravenous Ig and intravenous cyclophosphamide.

Matched MeSH terms: Purpura, Schoenlein-Henoch/diagnosis*

Clostridium difficile-related necrotizing pseudomembranous enteritis in association with Henoch-Schonlein purpura

Boey CC, Ramanujam TM, Looi LM

J Pediatr Gastroenterol Nutr, 1997 Apr;24(4):426-9.

PMID: 9144126

Matched MeSH terms: Purpura, Schoenlein-Henoch/complications*

Fulltext Efficacy of helicobacter pylori eradication as an upfront treatment of secondary immune thrombocytopenia: an experience from Pakistan

Sultan S, Irfan SM, Kaker J, Hasan M

Med J Malaysia, 2016 04;71(2):53-6.

PMID: 27326941

BACKGROUND: The effect of Helicobacter-pylori eradication therapy on the platelet counts in patients with immune thrombocytopenia is still debatable. The aim of this study was to assess the response rates of standard triple eradication therapy in secondary immune thrombocytopenia with Helicobacter pylori infection.

METHODS: From January 2012 to December 2013, 197 patients were diagnosed to have immune thrombocytopenia, out of which 22(11.1%) patients infected with Helicobacter- Pylorus were enrolled in this study. Helicobacter-Pylori infection was documented by Helicobacter-pylori stool antigen enzyme immunoassay method. All positive patients were put on triple eradication therapy. The responses rates to treatment were defined as per International Working Group on ITP.

RESULTS: Mean age of patients was 43.18±12.5 years. There were 10(45.5%) males and 12 (54.5%) females. Of the 22 patients, 7(31.8%) exhibited a complete response (CR) to Hpylori eradication therapy; 10(45.4%) attained a response; and 5(22.7%) had no response. Mean base line platelet counts were 53.36±24.5x109/l, while platelet counts at 4 week following eradication was 80.86±51.0x109/l (P=0.003). The predictive factor of response following eradication therapy was baseline platelet counts. Virtually all responders had baseline platelet counts >30x109/l and all non-responders had <30x109/l of platelet counts.

CONCLUSIONS: Though the prevalence of H-pylori is low, this study confirmed the efficacy of eradication in increasing the platelet counts in H-pylori positive patients with ITP. It is an important measure in short time, safe and very cost effective to achieve platelets increment. We endorse the routine detection and eradication treatment of H-pylori infective ITP patients.

Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/complications*

A case of immune thrombocytopenic purpura with prolonged aPTT time: A clotter hidden in a bleeder?

Lee MH, Khoo PJ, Gew LT, Ng CF

Med J Malaysia, 2017 12;72(6):365-366.

PMID: 29308775 MyJurnal

We report the case of a 23-year-old woman who presented with prolonged menstruation and multiple bruises on the limbs and trunk. Investigations revealed severe thrombocytopenia and deranged coagulation profile with markedly prolonged activated partial thromboplastin time (aPTT). Lupus anticoagulant, anti-cardiolipin antibody and anti-beta-2-glycoprotein 1 antibody were positive. She was diagnosed with Immune Thrombocytopenic Purpura (ITP) with positive antiphospholipid antibody serology and given a course of intravenous methylprednisolone and tapering doses of oral prednisolone. She was steroid free and had no bleeding or thrombotic event over two years follow up.

Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/drug therapy*

Diabetic artefacts in forensic practice

Murty OP

J Forensic Leg Med, 2009 May;16(4):218-23.

PMID: 19329080 DOI: 10.1016/j.jflm.2008.07.010

A case is presented where confusion arose about skin lesions and whether they were diabetic or electrical in origin. The deceased was a known diabetic and hypertensive man. A middle-aged person in early fifties was found unconscious in the cell and judicial autopsy was performed. He was facing trial for capital punishment of being allegedly involved in drug trafficking and money laundering. He had few marks over his fingers and foot which were considered to be electric marks produced in electric torture. also had fracture of skull and ischemic necrosis of right side of cerebrum; and contrecoup lesions. Findings are documented with photographs of the lesions. The article also depicts photographs of the scene where the victim had fallen and sustained skull fracture.

Matched MeSH terms: Purpura/etiology; Purpura/pathology*

Fulltext Thrombotic thrombocytopenic purpura: three peripartum cases and diagnostic challenges

Ab Rahman WS, Abdullah WZ, Mustaffa R, Ahmed SA, Hassan MN, Husin A

Clin Med Insights Case Rep, 2013;6:141-6.

PMID: 24093001 DOI: 10.4137/CCRep.S12122

Thrombotic thrombocytopenic purpura (TTP) is a medical emergency characterized by occlusive microangiopathy due to intravascular platelet aggregation. This event results in damage to the red blood cells (RBCs) known as microangiopathic hemolytic anemia (MAHA). Schistocytes are circulating fragments of damaged RBCs that have different morphological features including keratocytes, helmet cells, and spherocytes. It is critical to report even a small number of these abnormal RBCs in the peripheral blood and to be alert for the possible diagnosis of TTP, especially in unexplained anemia and thrombocytopenia. The application of pentad criteria in the diagnosis has been reviewed, and the challenges still remained on the hematologic evidence of this disorder. In the 3 cases discussed here, the red cell morphological diagnosis gave an impact on TTP diagnosis, but overdiagnosis might be encountered in obstetrical patients due to nonspecific diagnostic criteria.

Matched MeSH terms: Purpura, Thrombotic Thrombocytopenic

Fulltext Dengue infections and circulating serotypes in Negeri Sembilan, Malaysia

Ahmad Nizal, M.G., Rozita, H., Mazrura, S., Zainudin, M.A., Hidayatulfathi, O., Faridah, M.A, et al.

Malaysian Journal of Public Health Medicine, 2012;12(1):21-30.

MyJurnal

This study observed the pattern of reported dengue infections, clinical manifestations, and circulating dengue serotypes in Negeri Sembilan, Malaysia. The aim of this study was to determine the co-circulation of the four different dengue virus serotypes in Negeri Sembilan. We analyzed the surveillance data (VEKPRO) from Negeri Sembilan State Health Department and National Public Health Laboratory, Malaysia on reported dengue infections from 1st January 2010 to 31st December 2010. There were 1466 reported dengue infections, 1342 (91.5%) cases were dengue fever (DF) and 124 (8.5%) were dengue hemorrhagic fever (DHF). The mean age was 32.2± 15.8 years old and most were young adults, aged 15 years old and older. Males (p < 0.05), and those residing in Seremban district (p < 0.05) were more likely to get dengue infections. Symptoms presented upon admission were fever (100%), headache (99.9%), myalgia and arthralgia (98.8%), rash(24.2%), petechiae (16.0%),bleeding tendencies (7.0%) and neurological deficits(1.2%). All four dengue serotypes (DEN 1 – 4) were present, the pre-dominant serotype was DEN-3, noted in January, then existed together with DEN-2 until around May. DEN-1 was the most pre-dominant circulating dengue serotype afterwards, reaching a peak in December 2010. Dengue affected all age groups particularly young adults and males. Most cases reported were in urban areas and Seremban district. Most of the dengue infections occurred in the first half of the year, with the DEN-2 and DEN-3 serotypes being the most predominant.

Matched MeSH terms: Purpura

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