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buy persuasive essay In adults, the main goal is to maintain platelet count greater than 30 × 103/mm3 (30 × 109/l), because below this count, the incidence of bleeding in increased. 31 »» general approach to treatment the treatment of itp is determined by the symptom severity. In some cases, no therapy is needed (table 67–8). The initial treatment of children with itp is controversial because greater than 75% to 80% of cases resolve spontaneously irrespective of pharmacologic intervention. Therapy should be given to children with severe hemorrhage. Therapy may be considered in children meeting one of the following criteria. Platelet counts less than 10 × 103/mm3 (10 × 109/l) and mucocutaneous bleeding. Platelet counts less than 30 × 103/mm3 (30 × 109/l) and moderate patient encounter 2, part 2. Itp pe. Wt 75 kg. Vital signs within normal limits. Petechial rash present on lower extremities. Bleeding mucous surfaces noted within oral cavity. Labs. •• platelet count. 8 × 103/mm3 (8 × 109/l) (normal 140–440 × 103/mm3 [140–440 × 109/l]) •• aptt. 35 seconds (normal 25–40 seconds) •• pt. 11 seconds (normal 10–12 seconds) •• hemoglobin 13 g/dl (130 g/l or 8. 07 mmol/l) (normal 13. 8–17. 2 g/dl or 138–172 g/l or 8. 57–10. 68 mmol/l) •• hcv antibody negative •• hiv negative given this additional information, is this patient’s presentation consistent with itp?. Identify your treatment goals for this patient. Table 67–8  guidelines for the management of adult itp greater than 30 × 103 platelets/ no treatment mm3 (30 × 109/l), no bleeding first line prednisone (1 mg/kg/day)   less than 30 × 103 platelets/ anti-d immune globulin mm3 (30 × 109/l), bleeding (50–75 mcg/kg/day, × one symptoms dose) if corticosteroids contraindicated ivig (1 g/kg/day × one dose, repeat as necessary) if corticosteroids contraindicated second line splenectomy  reserved for patients with rituximab (375 mg/m2 once bleeding symptoms and weekly for four doses) platelets < 30 × 103 platelets/ eltrombopag (25–75 mg daily) mm3 (30 × 109/l) after an romiplostim (1–10 mcg/kg) adequate trial of first-line immunosuppressants agents hemorrhage platelet transfusion ivig (1 g/kg/day × one dose, repeat as necessary)   methylprednisolone (1 g/day for 3 days) systemic or mucosal bleeding. Or factors that may increase the risk of bleeding (such as participation in active contact sports increasing risk of head injury). 32 in adults, treatment is indicated when platelet counts are less than 30 × 103/mm3 (30 × 109/l). 31 »» nonpharmacologic therapy splenectomy  in adults, splenectomy is generally considered after 3 to 6 months if the patient continues to require 10 to 20 mg/day of prednisone to maintain the platelet count greater than 30 × 103/mm3 (30 × 109/l). Splenectomy may also be considered for urgent treatment of neurologic symptoms or for managing relapse despite an adequate trial of corticosteroids, iv immunoglobulin (ivig), or anti-rh(d). Even though individual patient response cannot be predicted, approximately two-thirds of refractory adult patients have a favorable response to splenectomy within several days. However, 30% to 40% will have no response or will experience a relapse sometime after splenectomy. In children, splenectomy is usually reserved due to the selflimited nature of itp and fear of infectious complications of splenectomy. Splenectomy is recommended in children with itp duration greater than 1 year with significant bleeding symptoms and unresponsive or intolerant of pharmacological therapies.

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http://manila.lpu.edu.ph/about.php?test=self-assessment-essay self assessment essay 2005;365:1644–1646. 16. Jorgensen jo, feldt-rasmussen u, frystyk j, et al. Cotreatment of acromegaly with a somatostatin analog and a growth hormone receptor antagonist. J clin endocrinol metab. 2005;90. 5627–5631. 17. Neggers sj, van aken mo, janssen ja, et al. Long-term efficacy and safety of combined treatment of somatostatin analogs and pegvisomant in acromegaly. J clin endocrinol metab. 2007;92. 4598–4601. 18. Neggers sj, de herder ww, janssen ja, et al. Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant. Long-term safety for up to 4. 5 years (median 2.

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