Aashi
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A 35-year-old healthy white woman presents to your office complaining of three weeks of bleeding gums after she brushes her teeth. She otherwise feels well and has no other complaints. Her dentist says that she has healthy teeth and gums. She has no significant past medical history and does not take any medications. She is a nonsmoker and does not drink alcohol. She is married and has two healthy young children.
Physical examination: blood pressure 132/72 mm Hg; heart rate 60/min; respiratory rate 12/min; temperature 98.5 F
HEENT: good dentition; no gingival hypertrophy or discoloration; no gingival tenderness upon palpation; no oral lesions
Heart: S1, S2, no murmurs
Extremities: no edema
White blood cell count 5,600/mm3; hematocrit 41%; platelets 9,000/mm3
Which of the following is the most specific finding for this patient's condition?
(A) An enlarged spleen
(B) A positive monospot test
(C) A diminished number of megakaryocytes
(D) Antiplatelet antibodies
(E) Hemolysis on peripheral smear
(F) Increased megakaryocytes
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| ling
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d ?
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| chemamr
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D?
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| robin082006
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D
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| Aashi
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 guys it is TRICKY
Try again
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| robin082006
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This may be immune thrombocytopenia.
if D is not the correct answer,
Next is F
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| chemamr
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f?
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| prathapdoctor
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this is surely immune thrombocytopenia, F is looking fair to me after D.
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| Aashi
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Answer:
(F) Increased megakaryocytes
Explanation:
This is most likely a case of idiopathic thrombocytopenic purpura (ITP). ITP occurs in women three times as frequently as in men and most commonly presents between the ages of 20 to 50. These patients will usually present with signs of superficial bleeding, such as that of the mucosa, epistaxis, skin, gingival, and vagina. In children, ITP is usually precipitated by a viral illness, such as Epstein-Barr virus (EBV), and, therefore, a positive Monospot test can be found.
In adults, there is rarely an association with a specific virus. ITP is an autoimmune disease in which immunoglobulin G (IgG) antibody is produced against glycoprotein IIb/IIIa antigens on the platelet surface. The platelets are not lysed. Instead, macrophages will bring the platelets to the spleen where the destruction will take place. This is why splenectomy is the definitive treatment, even if there is no splenomegaly on examination. Despite the destruction taking place in the spleen, the spleen does not become enlarged.
Bone marrow examination should reveal an increased number of megakaryocytes, with the other cell lines being normal because there is no production problem in ITP. There is no hemolysis in ITP: Hemolysis is found in hemolytic uremic syndrome (HUS), disseminated intravascular coagulation (DIC), and thrombotic thrombocytopenic purpura (TTP), not ITP.
ITP is diagnosed on the basis of a generally healthy person who develops an isolated thrombocytopenia with no identifiable cause, such as marrow infiltration or as a drug effect in a person with a normal-sized spleen. Bone marrow biopsy and an antinuclear antibody test are routinely done. Antiplatelet-antibody testing is not useful to confirm the diagnosis. Although antiplatelet antibodies are often present, their specificity is poor. Many normal subjects harbor antiplatelet antibodies without a low platelet count. You can also have ITP without antiplatelet antibodies present..
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| liwei
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D is more specific
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