Idiopathic Thrombocytopenic Purpura (ITP) | Case Study

Running head: CASE STUDY
CASE STUDY
Name of the Student
Name of the University:
Author Note:

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Answer 1.
The clinical scenario presented here is indicating that Ms. ABC experienced all those
clinical conditions as a result of Idiopathic thrombocytopenic purpura (ITP) along with diabetic
ketoacidosis.
Answer 2.
The patient was recently diagnosed with type 2 diabetes mellitus, which can be
commonly associated with hyperglycemia. Hyperglycemia can often be associated with diabetic
ketoacidosis. She was also diagnosed with thrombocytopenia, which is a possible preceding
condition of the diabetic ketoacidosis as well. Ms. ABC is currently experiencing the symptoms
like polyuria, polydipsia, weight loss and decreased vision problems, which can be associated
with the symptoms of hyperglycemic condition in the patient.
Ms. ABC has a sodium level that is lower compared to the normal range. Thus she has a
hyponatremia condition, which can be associated with the hyperglycemic condition in her (Sahay
& Sahay, 2014). However her potassium level is normal. Her CO2 level is also lower than
normal, which is a common manifestation for the diabetic ketoacidosis condition. The calcium
level, BUN level and the creatinine level in her again can be considered as normal. The sugar
level 573 mg/dl indicates that the patient has hyperglycemia. The albumin level, AST level and
the ALT level can also be considered as normal. These results indicate that the patient does not
have any immediate risks for a damage to kidney or damage to other organs (Nardocciet al.,
2015). The WBC count along with the hematocrit level and the hemoglobin level is normal in
Ms ABC, which suggests that she has not encountered any microbial infection (Honda, Uehara,

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Matsumoto, Arai & Sugano, 2016). However, her platelet count is dangerously lower than
normal, which is a clinical manifestation for her thrombocytopenia condition (Liu et al., 2016).
Answer 3.
The patient was receiving a steroid treatment for her eye conditions. It has been found
from a study that steroid treatment might lead to the development of type 2 diabetes mellitus in
the patients. Along with that, she also started taking methotrexate again after stopping to take it 2
weeks ago. It has been found from a study that methotrexate can induce a metabolic acidosis
condition in the patient like diabetic ketoacidosis in the diabetic patients (Pham, Xu & Moe,
2015). Hence, it can be decided that the patient developed type 2 diabetes mellitus from steroid
treatment, which resulted in a hyperglycemic condition in her. Then when she started taking
methotrexate, there was a development of drug induced diabetic ketoacidosis in the patient.
Answer 4.
(a) Ms. ABC was diabetic and thus her blood glucose level was high. That means her
blood had high osmolarity. The scenario led to the efflux of the glucose and other
electrolytes like sodium through urine. This led to hyponatremia condition, the
polyuria and the polydipsia condition in her along with decreased night vision or eye
damage. The absence of a proper insulin activity also led to increased release of fatty
acids from the adipose tissues, which were converted to ketone bodies, which were
supposed to serve as an energy source. However, those ketone bodies increased the
acidity of the blood also, which led to diabetic ketoacidosis condition. The
methotrexate also contributed in the development of this metabolic acidosis. The

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conditions proceeded to thrombocytopenia (Komoğlu, Silte, Sertbaş, Sertbaş &
Özdemir, 2015).
(b) She will be experiencing a prolonged bleeding. She is at huge risk of experiencing
internal bleeding.
(c) She must receive a platelet transfusion in order to treat her thrombocytopenia
condition. From her physical examination, the presence of scattered petechiae was
also found, which means that her internal bleeding has already started. Now in order
to prevent severe hemorrhage conditions her platelet count must be restored to
normal. The thrombocytopenia resulting from diabetic ketoacidosis might also lead to
multi-organ failure (Alsaied, Goldstein, Kaddourah & Poynter, 2016). Thus the
condition should be urgently treated in order to prevent that possibility.
(d) Thromboprotein is a hormone that stimulates the production of the platelets. It is
produced in the kidney and liver. In this case scenario, the thromboprotein action was
compromised in the thrombocytopenia condition (Kinoshita et al., 2018).
(e) In ITP condition, the spleen responsible for attacking the platelets and destroying
them (Antel, Panieri & Novitzky, 2015). Thus it is considered to be helpful if the
spleen is removed in the condition.
Answer 5.
1. The possibility of severe internal bleeding in her, which can be monitored by
checking possible bruise formations in her (Middelburg, Carbaat-Ham, Hesam,
Ragusi & Zwaginga, 2016).

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2. The possibility of multi-organ failure in her, which can be monitored by continuously
checking the creatinine level and BUN level in her (Burke, Schumacher & Harpe,
2017).

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References:
Alsaied, T., Goldstein, S. L., Kaddourah, A., & Poynter, S. E. (2016). Thrombocytopenia‐
associated multi‐organ failure caused by diabetic ketoacidosis. Pediatrics
International, 58(3), 232-234. https://doi.org/10.1111/ped.12780
Antel, K. R., Panieri, E., & Novitzky, N. (2015). Role of splenectomy for immune
thrombocytopenic purpura (ITP) in the era of new second-line therapies and in the setting
of a high prevalence of HIV-associated ITP. South African Medical Journal, 105(5), 408-
412. DOI: 10.7196/SAMJ.8987
Burke, K. R., Schumacher, C. A., & Harpe, S. E. (2017). SGLT 2 inhibitors: a systematic review
of diabetic ketoacidosis and related risk factors in the primary
literature. Pharmacotherapy: The Journal of Human Pharmacology and Drug
Therapy, 37(2), 187-194. https://doi.org/10.1002/phar.1881
Honda, T., Uehara, T., Matsumoto, G., Arai, S., & Sugano, M. (2016). Neutrophil left shift and
white blood cell count as markers of bacterial infection. Clinica Chimica Acta, 457, 46-
53. https://doi.org/10.1016/j.cca.2016.03.017
Kinoshita, T., Kamei, S., Nakamura, Y., Shimoda, M., Anno, T., Obata, A., ... & Nakanishi, S.
(2018). Onset of type 1 diabetes mellitus and heparin‐induced thrombocytopenia in a
patient with Basedow's disease and idiopathic thrombocytopenic purpura: Novel
combination as autoimmune polyglandular syndrome. Journal of diabetes
investigation, 9(6), 1381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215937/

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Komoğlu, S., Silte, D., Sertbaş, M., Sertbaş, Y., & Özdemir, A. (2015). Methorexate therapy in a
patient with rheumatoid arthritis complicated by idiopathic thrombocytopenic
purpura. European journal of rheumatology, 2(1), 39.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047244/
Liu, Y., Chen, S., Sun, Y., Lin, Q., Liao, X., Zhang, J., ... & Shi, G. (2016). Clinical
characteristics of immune thrombocytopenia associated with autoimmune disease: a
retrospective study. Medicine, 95(50).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268034/
Middelburg, R. A., Carbaat-Ham, J. C., Hesam, H., Ragusi, M. A., & Zwaginga, J. J. (2016).
Platelet function in adult ITP patients can be either increased or decreased, compared to
healthy controls, and is associated with bleeding risk. Hematology, 21(9), 549-551.
https://doi.org/10.1080/10245332.2016.1180097
Nardocci, G., Martin, A., Abarzúa, S., Rodríguez, J., Simon, F., Reyes, E. P., ... & Fernández, R.
(2015). Sepsis progression to multiple organ dysfunction in carotid chemo/baro-
denervated rats treated with lipopolysaccharide. Journal of neuroimmunology, 278, 44-
52. https://doi.org/10.1016/j.jneuroim.2014.12.002
Pham, A. Q. T., Xu, L. H. R., & Moe, O. W. (2015). Drug-induced metabolic
acidosis. F1000Research, 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754009/
Sahay, M., & Sahay, R. (2014). Hyponatremia: a practical approach. Indian journal of
endocrinology and metabolism, 18(6), 760.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192979/

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