Case report of idiopathic thrombocytopenic purpura and tuberculosis in a 47-year-old male
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Feb 27, 2024
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Abstract
Idiopathic Thrombocytopenic Purpura (ITP) is a condition of low platelet count of unknown cause where most of the causes of ITP are the result of antibodies binding to platelets. One of the extra pulmonary manifestations of TB occurs in the hematological system which can cause anemia, leukopenia, leukocytosis, thrombocytopenia and thrombocytosis and ITP due to Tuberculosis (TB) is a rare manifestation of TB. This case report aims to describe a 47 year old male patient with ITP accompanied by TB. A 47 year old male patient came with complaints of weakness since 7 days ago. Based on the history, physical and supporting examinations carried out, the patient was diagnosed with ITP due to pulmonary TB. Manifestations of ITP due to TB are similar to ITP in general. Generalized purpura, bruising after minor trauma, epistaxis, subconjunctival hemorrhage and hematuria are possible manifestations. Treatment for ITP is to treat the underlying disease that causes it and specific treatment for ITP can also be given if the patient's platelets are very low. The specific treatment for ITP that can be given is corticosteroids or IVIG. Idiopathic Thrombocytopenic Purpura is a rare hematological manifestation of TB. Correct diagnosis and treatment play an important role in reducing the worsening prognosis of ITP patients due to TB.
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How to Cite
Yudo Krisyulianto, I. L. and Mulyono, E. (2024) “Case report of idiopathic thrombocytopenic purpura and tuberculosis in a 47-year-old male”, Science Midwifery, 11(6), pp. 910-916. doi: 10.35335/midwifery.v11i6.1419.
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Charifa, A., Mangat, R., & Oakley, A. (2023). Cutaneous tuberculosis. StatPearls.
DeSouza, S., & Angelini, D. (2021). Updated guidelines for immune thrombocytopenic purpura: Expanded management options. Cleveland Clinic Journal of Medicine, 88(12), 664–668.
Gauer, R. L., & Braun, M. M. (2012). Thrombocytopenia. American Family Physician, 85(6), 612–622.
Haider, M. S., Mahmood, A., Bozdar, M., Zahir, S., Muzafar, S., & Bukhari, M. B. (2022). Significance of Immature Platelet Fraction in Diagnosed Patients of the Immune Thrombocytopenic Purpura. Pakistan Armed Forces Medical Journal, 72(4), 1420–1423.
Kashiwagi, H., Kuwana, M., Hato, T., Takafuta, T., Fujimura, K., Kurata, Y., Murata, M., Tomiyama, Y., & Committee for the Revision of “Reference Guide for Management of adult ITP” Blood Coagulation Abnormalities Research Team Labour and Welfare Science Research Grants, R. on R. and I. D. supported by H. (2020). Reference guide for management of adult immune thrombocytopenia in Japan: 2019 Revision. International Journal of Hematology, 111, 329–351.
Kayal, L., Jayachandran, S., & Singh, K. (2014). Idiopathic thrombocytopenic purpura. Contemporary Clinical Dentistry, 5(3), 410.
Khan, A. A., Shahzad, A., Javid, H., Fatima, T., & Yousaf, Z. (2021). Immune thrombocytopenia associated with tuberculosis–a case report. IDCases, 23, e01012.
Kuter, D. J. (2019). General aspects of thrombocytopenia, platelet transfusions, and thrombopoietic growth factors. In Consultative hemostasis and thrombosis (pp. 108–126). Elsevier.
Mititelu, A., Onisâi, M.-C., Roșca, A., & Vlădăreanu, A. M. (2024). Current Understanding of Immune Thrombocytopenia: A Review of Pathogenesis and Treatment Options. International Journal of Molecular Sciences, 25(4), 2163.
Mohamed, S. F., Alkhatib, M., Elfert, K., Othman, A., Soliman, D. S., Nashwan, A. J., Imam, Y., & Yasin, M. A. (2020). Tuberculosis with Immune Thrombocytopenia an Unusual Association. Blood, 136, 12.
Onisâi, M., Vlădăreanu, A.-M., Spînu, A., Găman, M., & Bumbea, H. (2019). Idiopathic thrombocytopenic purpura (ITP)–new era for an old disease. Romanian Journal of Internal Medicine, 57(4), 273–283.
Park, Y. H., Kim, D.-Y., Kim, S., Choi, Y. B., Shin, D.-Y., Kim, J. S., Lee, W. S., Mun, Y.-C., Jang, J. H., & Lee, J. W. (2022). Management of immune thrombocytopenia: 2022 update of Korean experts recommendations. Blood Research, 57(1), 20–28.
Porcelijn, L., Schmidt, D. E., Oldert, G., Hofstede-van Egmond, S., Kapur, R., Zwaginga, J. J., & de Haas, M. (2020). Evolution and utility of antiplatelet autoantibody testing in patients with immune thrombocytopenia. Transfusion Medicine Reviews, 34(4), 258–269.
Robier, C. (2020). Platelet morphology. Journal of Laboratory Medicine, 44(5), 231–239.
Sandal, R., Mishra, K., Jandial, A., Sahu, K. K., & Siddiqui, A. D. (2021). Update on diagnosis and treatment of immune thrombocytopenia. Expert Review of Clinical Pharmacology, 14(5), 553–568.
Santoshi, R. K., Patel, R., Patel, N. S., Bansro, V., Chhabra, G., & Chhabra, G. S. (2022). A comprehensive review of thrombocytopenia with a spotlight on intensive care patients. Cureus, 14(8).
Scharf, R. E. (2021). Thrombocytopenia and hemostatic changes in acute and chronic liver disease: pathophysiology, clinical and laboratory features, and management. Journal of Clinical Medicine, 10(7), 1530.
Tărniceriu, C. C., Hurjui, L. L., Florea, I. D., Hurjui, I., Gradinaru, I., Tanase, D. M., Delianu, C., Haisan, A., & Lozneanu, L. (2022). Immune Thrombocytopenic Purpura as a Hemorrhagic Versus Thrombotic Disease: An Updated Insight into Pathophysiological Mechanisms. Medicina, 58(2), 211.
Thakre, R., Gharde, P., & Raghuwanshi, M. (2023). Idiopathic Thrombocytopenic Purpura: Current Limitations and Management. Cureus, 15(11).
Thaware, A., Khadatkar, M., Pathade, A., & Alnewar, P. (2022). A Case of Idiopathic Thrombocytopenic Purpura. International Journal of Early Childhood Special Education, 14(4).
Weber, S., Arnold, J. B. Z., Sachs, U. J., & Luppa, P. B. (2024). Recombinantly Expressed Tagged SUrface Protein (RETSUP) assay: a new diagnostic system for the detection of antibodies to platelets. Journal of Thrombosis and Haemostasis.
Yadav, P., Gokhale, V. S., Parati, R., & Mehta, K. (2021). A rare presentation of immune thrombocytopenic purpura. International Journal of Research in Medical Sciences, 9(12), 3692.
Zaninetti, C., & Greinacher, A. (2020). Diagnosis of inherited platelet disorders on a blood smear. Journal of Clinical Medicine, 9(2), 539.
Alkhatib, M., Elfert, K. A., Saleh, A. O., Elkourashy, S. A., Fadul, A. M., Taha, R. Y., Imam, Y. Z., & Fareed, S. (2021). Tuberculosis with immune thrombocytopenia: Case reports and review of the literature. Medicine: Case Reports and Study Protocols, 2(3), e0062.
Charifa, A., Mangat, R., & Oakley, A. (2023). Cutaneous tuberculosis. StatPearls.
DeSouza, S., & Angelini, D. (2021). Updated guidelines for immune thrombocytopenic purpura: Expanded management options. Cleveland Clinic Journal of Medicine, 88(12), 664–668.
Gauer, R. L., & Braun, M. M. (2012). Thrombocytopenia. American Family Physician, 85(6), 612–622.
Haider, M. S., Mahmood, A., Bozdar, M., Zahir, S., Muzafar, S., & Bukhari, M. B. (2022). Significance of Immature Platelet Fraction in Diagnosed Patients of the Immune Thrombocytopenic Purpura. Pakistan Armed Forces Medical Journal, 72(4), 1420–1423.
Kashiwagi, H., Kuwana, M., Hato, T., Takafuta, T., Fujimura, K., Kurata, Y., Murata, M., Tomiyama, Y., & Committee for the Revision of “Reference Guide for Management of adult ITP” Blood Coagulation Abnormalities Research Team Labour and Welfare Science Research Grants, R. on R. and I. D. supported by H. (2020). Reference guide for management of adult immune thrombocytopenia in Japan: 2019 Revision. International Journal of Hematology, 111, 329–351.
Kayal, L., Jayachandran, S., & Singh, K. (2014). Idiopathic thrombocytopenic purpura. Contemporary Clinical Dentistry, 5(3), 410.
Khan, A. A., Shahzad, A., Javid, H., Fatima, T., & Yousaf, Z. (2021). Immune thrombocytopenia associated with tuberculosis–a case report. IDCases, 23, e01012.
Kuter, D. J. (2019). General aspects of thrombocytopenia, platelet transfusions, and thrombopoietic growth factors. In Consultative hemostasis and thrombosis (pp. 108–126). Elsevier.
Mititelu, A., Onisâi, M.-C., Roșca, A., & Vlădăreanu, A. M. (2024). Current Understanding of Immune Thrombocytopenia: A Review of Pathogenesis and Treatment Options. International Journal of Molecular Sciences, 25(4), 2163.
Mohamed, S. F., Alkhatib, M., Elfert, K., Othman, A., Soliman, D. S., Nashwan, A. J., Imam, Y., & Yasin, M. A. (2020). Tuberculosis with Immune Thrombocytopenia an Unusual Association. Blood, 136, 12.
Onisâi, M., Vlădăreanu, A.-M., Spînu, A., Găman, M., & Bumbea, H. (2019). Idiopathic thrombocytopenic purpura (ITP)–new era for an old disease. Romanian Journal of Internal Medicine, 57(4), 273–283.
Park, Y. H., Kim, D.-Y., Kim, S., Choi, Y. B., Shin, D.-Y., Kim, J. S., Lee, W. S., Mun, Y.-C., Jang, J. H., & Lee, J. W. (2022). Management of immune thrombocytopenia: 2022 update of Korean experts recommendations. Blood Research, 57(1), 20–28.
Porcelijn, L., Schmidt, D. E., Oldert, G., Hofstede-van Egmond, S., Kapur, R., Zwaginga, J. J., & de Haas, M. (2020). Evolution and utility of antiplatelet autoantibody testing in patients with immune thrombocytopenia. Transfusion Medicine Reviews, 34(4), 258–269.
Robier, C. (2020). Platelet morphology. Journal of Laboratory Medicine, 44(5), 231–239.
Sandal, R., Mishra, K., Jandial, A., Sahu, K. K., & Siddiqui, A. D. (2021). Update on diagnosis and treatment of immune thrombocytopenia. Expert Review of Clinical Pharmacology, 14(5), 553–568.
Santoshi, R. K., Patel, R., Patel, N. S., Bansro, V., Chhabra, G., & Chhabra, G. S. (2022). A comprehensive review of thrombocytopenia with a spotlight on intensive care patients. Cureus, 14(8).
Scharf, R. E. (2021). Thrombocytopenia and hemostatic changes in acute and chronic liver disease: pathophysiology, clinical and laboratory features, and management. Journal of Clinical Medicine, 10(7), 1530.
Tărniceriu, C. C., Hurjui, L. L., Florea, I. D., Hurjui, I., Gradinaru, I., Tanase, D. M., Delianu, C., Haisan, A., & Lozneanu, L. (2022). Immune Thrombocytopenic Purpura as a Hemorrhagic Versus Thrombotic Disease: An Updated Insight into Pathophysiological Mechanisms. Medicina, 58(2), 211.
Thakre, R., Gharde, P., & Raghuwanshi, M. (2023). Idiopathic Thrombocytopenic Purpura: Current Limitations and Management. Cureus, 15(11).
Thaware, A., Khadatkar, M., Pathade, A., & Alnewar, P. (2022). A Case of Idiopathic Thrombocytopenic Purpura. International Journal of Early Childhood Special Education, 14(4).
Weber, S., Arnold, J. B. Z., Sachs, U. J., & Luppa, P. B. (2024). Recombinantly Expressed Tagged SUrface Protein (RETSUP) assay: a new diagnostic system for the detection of antibodies to platelets. Journal of Thrombosis and Haemostasis.
Yadav, P., Gokhale, V. S., Parati, R., & Mehta, K. (2021). A rare presentation of immune thrombocytopenic purpura. International Journal of Research in Medical Sciences, 9(12), 3692.
Zaninetti, C., & Greinacher, A. (2020). Diagnosis of inherited platelet disorders on a blood smear. Journal of Clinical Medicine, 9(2), 539.