CASE STUDY - 5

CHRONIC IMMUNE THROMBOCYTOPENIA

PURPURA

PRESENTED TO - Mrs. Ruma Singh

PRESENTED BY - Navnoor Kaur
PATIENT’S PROFILE
NAME-XYZ
AGE- 37 years
GENDER- Male
HEIGHT- 156 cm.
WEIGHT- 71.1 kgs.
BMI-29.2 kg/m2
IBW- 56 kgs.
OCCUPATION- Businessman
WARD- 15
DOCTOR IN CHARGE- Dr. Joseph John
SOCIO- ECONOMIC STATUS- Middle class
ACTIVITY- Sedentary
DOA - 10.11.23
DOD - 14.11.23
 MEDICAL PROFILE
PAST MEDICAL HISTORY CHIEF COMPLAINTS
No such medical history in Low Platelet Count (5000)
patient or family Rashes on Both thighs x 1 day

MEDICAL DIAGNOSIS
Chronic Immune Thrombocytopenia
ANATOMY OF THE ORGANS AFFECTED

BLOOD
 BLOOD
Blood is a fluid connective tissue that circulates
throughout the body, delivering oxygen and
nutrients to cells and tissues.
It has four main components: plasma, red
blood cells, white blood cells, and platelets.
Blood has many different functions, including:
Transporting oxygen and nutrients to the lungs
and tissues
Forming blood clots to prevent excess blood
loss
Carrying cells and antibodies that fight
infection
Bringing waste products to the kidneys and
liver, which filter and clean the blood
Regulating body temperature
PLASMA
Plasma is the largest part of your blood.
It makes up more than half (about 55%)
of its overall content.
When separated from the rest of the
blood, plasma is a light yellow liquid.
Plasma carries water, salts, and enzymes.

RED BLOOD CELLS

Erythrocytes, red blood cells (RBC), the
functional component , responsible for the
transportation of gases and nutrients
throughout the human body.
Their unique shape and composition allow for
these specialized cells to carry out their
essential functions.
WHITE BLOOD CELLS
White blood cells, also known as leukocytes,
are responsible for protecting your body,from
infection.
White blood cells account for 1% of your blood.
White blood cell formation occurs in the soft
tissue inside of your bones (bone marrow).
Two types of white blood cells (lymphocytes)
grow in the thymus gland (T cells) and lymph
nodes and spleen (B cells).
There are five types of white blood cells:
Neutrophils
Lymphocytes
Eosinophils
Monocytes
Basophils
PLATELETS
Platelets, or thrombocytes, are small, colorless
cell fragments in our blood that form clots and
stop or prevent bleeding.
Platelets are made in our bone marrow, the
sponge-like tissue inside our bones.
A normal platelet count ranges from 150,000 to
450,000 platelets per microliter of blood.
Having more than 450,000 platelets is a
condition called thrombocytosis; having less
than 150,000 is known as thrombocytopenia.
CHRONIC IMMUNE THROMBOCYTOPENIA PURPURA
Immune thrombocytopenia (ITP) is a type of platelet disorder.
In ITP, the blood does not clot as it should, because of low platelet count.
ITP can be acute (short-term) or chronic (long-term).
Chronic ITP lasts 6 months or longer and mostly affects adults.
In ITP, the immune system mistakenly targets and destroys platelets,
leading to their decreased lifespan and lower numbers in the bloodstream.
SYMPTOMS

Petechiae Rashes
Gum Bleeding
Nose Bleeding
Black mouth blisters
Bruising
Fatigue
COMPLICATIONS
OF CHRONIC ITP
Hemorrhage
Bleeding complications-
Gastrointestinal Bleeding
Hematuria
Menorrhagia in females
RISK FACTORS
Have certain types of cancer, or autoimmune
diseases
Are exposed to certain toxic chemicals
Have a reaction to certain medicines
Have certain viruses
Have certain genetic conditions
 VITALS
PULSE B.P. RESP. TEMP.

NORMAL 72/min 120/80 mmHg 24/min 98.4°F

10/11/23 86/min 120/70 mmHg 22/min 97.6°F

11/11/23 94/min 110/80 mmHg 20/min 99.2°F

12/11/23 80/min 110/80 mmHg 18/min 98.8°F

 BIOCHEMICAL PARAMETERS
HB UREA/
(gm/dl) MCV TLC PLT CREAT Potassium Chloride

1.5
13-15 4000-
lakhs- 3.5-5.2 96-106
NORMAL (gm/ 80-100fl 11000/mi 0.7-1.2
4.10 mEq/L mEq/L
dl) crolitre
lakhs

23/11/23 14.2 79.2 7600 18,000 17.50/0.64 4.08 105

DRUG THERAPY
 MEDICATIONS
MEDICATION DOSE ROUTE FUNCTION SIDE-EFFECTS

B-vitamin
Tab. Folate 5mg P/O Nausea, Diarrhoea
Supplement

Syp. Vitamin
5ml P/O Vitamin D Analog Stomach pain
D3

Inj. Thrombopoetin
125 mcg S/c Bruises, Indigestion
Romiplastim Receptor

Muscle pain,
Tab. Tranexa 1gm P/O antifibrinolytics
stiffness
DIET THERAPY
DIET
IMPLEMENTATION
DIET STARTED - 11.12.23
DIET IMPLEMENTED- 60gm LowSalt
Neutropenic Light diet
FOODS TO BE INCLUDED
Higher intake of fresh, whole foods, such as fruits, vegetables, nuts, legumes,
and whole grains
Higher intake of leafy green vegetables, such as, spinach which contain high
amounts of vitamin K, calcium, and other minerals to support clotting and
potentially reduce fatigue

FOODS TO BE AVOIDED
Canned and frozen foods and leftovers. The nutritional value of food deteriorates with
time.
White flour, white rice and processed foods.
Hydrogenated, partially hydrogenated or trans-fats.
Sugar
Alcoholic beverages
FOOD HABITS - Vegetarian
FOOD ALLERGIES/ INTOLERANCES- Allergic to Ibuprofen
FAMILY TYPE- Nuclear
SOCIAL HISTORY- No history of Smoking/Alcohol
FOOD ITEMS PREFERRED
CEREALS - ALL
PULSES - ALL
MILK & MILK PRODUCTS - ALL
GREEN LEAFY VEG. - ALL
NON VEGETARIAN - ONLY EGG
ROOTS & TUBERS - ALL
OTHER VEGETABLES - ALL
FRUITS - FEW
FRIED FOODS - NO
COOKING OIL USED - MUSTARD OIL
SWEETS - NO
NUTS - FEW
SOFT DRINKS/ALCOHOL - NONE
SEASONINGS - FEW
EATING OUT - RARELY
 TYPICAL DAY’S HOME DIET
MEAL MENU SERVINGS

TEA 1 CUP
BREAKFAST
PARANTHA 1.5

FRUIT 1 SERVING
MID-MORNING
TEA 1 CUP

CHAPATI 2
LUNCH VEGETABLE 1 SERVING
CURD 1 SERVING

TEA 1 CUP
EVENING TEA
SNACKS 1 SERVING

CHAPATI 1.5
DINNER
VEGETABLE 1 SERVING
 HOSPITAL DIET
MEAL MENU SERVINGS
1 SERVING
DALIA
1 CUP
BREAKFAST TEA
2
BREAD SLICES

MID-MORNING VEGETABLE SOUP 1 SERVING

KHICHDI 1 SERVING
VEGETABLE 1 SERVING
LUNCH
DAL 1 SERVING
CURD 1 SERVING

TEA 1 CUP
EVENING TEA
BISCUITS 4

KHICHDI 1 SERVING
DINNER VEGETABLE 1 SERVING
DAL 1 SERVING

POST DINNER MILK 1 SERVING

 HOSPITAL DIET
MEAL MENU SERVINGS
1 SERVING
DALIA
1 CUP
BREAKFAST TEA
2
BREAD SLICES

MID-MORNING VEGETABLE SOUP 1 SERVING

KHICHDI 1 SERVING
VEGETABLE 1 SERVING
LUNCH
DAL 1 SERVING
CURD 1 SERVING

TEA 1 CUP
EVENING TEA
BISCUITS 4

KHICHDI 1 SERVING
DINNER VEGETABLE 1 SERVING
DAL 1 SERVING

POST DINNER MILK 1 SERVING

 DIETARY ANALYSIS
ENERGY (Kcal) PROTEIN (g) CHO (g) FAT (g)

RDA 2730 54 130 25

MDA 1500 60 236 35

HOME DIET 1637 52 277 36

HOSPITAL DIET 1531 60 232 40

ACTUAL DIET 1531 60 232 40

 ENERGY DISTRIBUTION (Kcal)
3000

2500

2000

1500

1000

500

0
RDA MDA HOME DIET HOSPITAL DIET ACTUAL DIET
 PROTEIN DISTRIBUTION (g)
70

60

50

40

30

20

10

0
RDA MDA HOME DIET HOSPITAL DIET ACTUAL DIET
 FAT DISTRIBUTION (g)
40

30

20

10

0
RDA MDA HOME DIET HOSPITAL DIET ACTUAL DIET
CARBOHYDRATE DISTRIBUTION (g)
300

250

200

150

100

50

0
RDA MDA HOME DIET HOSPITAL DIET ACTUAL DIET
 ENERGY DISTRIBUTION
PROTEIN PROTEIN
16.5% 18.1%

FAT
9.6%
FAT
12%

CARBS
CARBS 69.9%
73.9%

HOSPITAL DIET ACTUAL DIET

BIBLIOGRAPHY
https://www.nhlbi.nih.gov/health/thrombocytopenia
https://my.clevelandclinic.org/health/diseases/14430-thrombocytopenia
https://www.ncbi.nlm.nih.gov/books/NBK542208/
Srilakshmi B., “Food Science”,(1997), New Age International (P) Ltd,
Publishers, Pune
https://www.ncbi.nlm.nih.gov/books/NBK2263/