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What is the cause and treatment of blue marks on the body?

Tuesday, 16 September 2003
Answered by: Shirish Kumar
Consultant Haematologist
Sir Ganga Ram Hospital
New Delhi
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Q. A boy about 12 developed blue marks all over his body. The parents ignored the symptoms and attributed those blue marks to his mischievous behaviour. Lately, a skin specialist was consulted who advised to take those marks seriously and go to some good hospital. The child was taken and admitted to a reputed private hospital in Delhi. A blood test was conducted and the platelet count was found to be below 20,000. The attending doctor prescribed platelet transfusion. The latest report suggests that the boys body is not producing bone marrow. So far about Rs 3,00,000 has been spent, the doctor says that the treatment can be done in USA and will cost Rs.50,000! and the chances of recovery are 50-50. Entire family is in dire state of mind. What can be done? Is it thrombocytopaenia? What does it mean? What option does the family have?

A.  Thrombocytopaenia is the decrease in platelet count below the normal level of 1,50,000/ul. There are many causes for it and usually a bone marrow examination is required to rule out some of them. In childhood, ITP is often preceded by a viral infection or vaccination. The disorder is usually self-limited, and spontaneous recovery occurs in a few weeks to several months. It is usually due to production of autoantibodies against platelets, and probably megakaryocytes (cells in the marrow which produce platelets), leading to the destruction of these cells. Treatment depends on the cause of the condition. In some cases, transfusion of platelets may be required to stop or prevent bleeding. If the doctor thinks a drug is the cause of the thrombocytopaenia, standard treatment involves discontinuing the drug. Infection, if present, is treated vigorously since control of the infection may result in a return of the platelet count to normal. The treatment of idiopathic thrombocytopaenic purpura is determined by the severity of the symptoms. In some cases, no therapy is needed. In most cases, drugs that alter the immune systems attack on the platelets are prescribed. These include corticosteroids (i.e., prednisone) and/or intravenous infusions of immune globulin. Another treatment that usually results in an increased number of platelet is removal of the spleen, the organ that destroys antibody-coated platelet. Other drugs such as vincristine, azathioprine (Imuran), Danazol, cyclophosphamide, and cyclosporine are prescribed for patients only in the severe case where other treatments have not shown benefit since these drugs have potentially harmful side effects.

A.  Thrombocytopaenia is the decrease in platelet count below the normal level of 1,50,000/ul. There are many causes for it and usually a bone marrow examination is required to rule out some of them. In childhood, ITP is often preceded by a viral infection or vaccination. The disorder is usually self-limited, and spontaneous recovery occurs in a few weeks to several months. It is usually due to production of autoantibodies against platelets, and probably megakaryocytes (cells in the marrow which produce platelets), leading to the destruction of these cells. Treatment depends on the cause of the condition. In some cases, transfusion of platelets may be required to stop or prevent bleeding. If the doctor thinks a drug is the cause of the thrombocytopaenia, standard treatment involves discontinuing the drug. Infection, if present, is treated vigorously since control of the infection may result in a return of the platelet count to normal. The treatment of idiopathic thrombocytopaenic purpura is determined by the severity of the symptoms. In some cases, no therapy is needed. In most cases, drugs that alter the immune systems attack on the platelets are prescribed. These include corticosteroids (i.e., prednisone) and/or intravenous infusions of immune globulin. Another treatment that usually results in an increased number of platelet is removal of the spleen, the organ that destroys antibody-coated platelet. Other drugs such as vincristine, azathioprine (Imuran), Danazol, cyclophosphamide, and cyclosporine are prescribed for patients only in the severe case where other treatments have not shown benefit since these drugs have potentially harmful side effects.

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