Hi,

     I am a 54 year old lady. For past ten years I've been getting perpura on my limbs. Those days, it was wrongly



diagnosed as allergy and I was advised to avoid preserved and artificially colored food. Now I am undergoing



treatment for ITP. After seeing some other platelet related diseases like may-hegglin anomaly, matching my symptoms I



want to be sure to eliminate any wrong diagnosis, especially before taking Danazol(200mg) capsules which I find are



notorious for hormonal side-effects. I am worried, Please help.



     During Dec-2009, I visited my family doctor for my fatigue, difficult breathing, hot flushes, heavy sweating



& giddiness which persisted from Aug-2009, that is from after my husband's bypass surgery. My appearance, weight,



blood sugar and HB were normal. So we thought these symptoms were related to worry or menopause. We checked blood



tests taken in the years before 13-Jan-2010, they all had platelet counts above 2,00,000 (Could have been



coincidential).



     Only once on December-2009, slight bleeding was noticed in my nose - never before, never after. On 13-Jan-



2010, the symptoms became worsened. Following the detection of low platelet count of 10,000 in the complete blood



count test, I was admitted in hospital. Only Telmekind(for Blood pressure), vitamins and intravenous glucose were



given when I was in hospital. No increased menstrual bleed. No mucosal bleed. No blood/platelet transfusion was done.



     The following tests were taken during my stay in hospital:

          1) The complete blood count tests showed progressive increase in platelets during stay in hospital



without any special medication. Initial test revealed platelets-25,000 , HB-11.5, WBC-5900,



AntiNuclearAntibody/ANA/ANF - +++ Speckled 1:40 DIL SubstrateHep2Cells, Coombs test - Negative, HIV - Negative, RBCs



- Predominantly normocytic normochromic cells, WBCs - Leucocytosis with mild relative lymphocytosis, Lupus



anticoagulant not detected, Blood group - A, & RH-typing - Positive, Neutrophils - 45%.

          2) Due to my giddiness and general weakness, CT scan was done and was normal.

          3) Bone marrow biopsy suggested "Fragmented Bone marrow (Trephine) Biopsy Showing mild



lymphocytosis".

          4) Bone marrow aspiration cytology suggested that "Touch imprints are cellular show drying artifacts.



However no obvious morphological abnormality is detected in the available material".

          5) Ultrasound whole abdomen - Liver, Gallbladder, Pancreas, spleen, kidneys, Uterus, ovaries all are



normal.





     The Hematologist there said that, no abnormality was found other than platelets. The discharge summary



concluded I had possible ITP thrombocytopenia.





     I was instructed to visit as an outpatient with CBC test every fortnight. I was prescribed Dapsone(100mg) &



Neurobion Forte during initial sessions from 27-Jan-2010. Platelet count bumped up to 2,03,000(yes, 2 lakhs & 3



thousand) . But due to severe alergic reactions(rashes, backpain & fever) Dapsone was immediately stopped.



     So from 18-Feb-2010, we switched to Folvite(5mg) + Cipcal(500mg) + Neurobion Forte Combination. The platelet



count dropped from 2,03,000 to 75,000. However, we continued with this combo to upto 02-Jun-2010. Following The



platelet count kept varying. Details follow:



     Date of CBC     -     Platelet count     -     Leucocytes     Neutrophil

     02-Mar-2010     -     75,000          -     8,950          20%

     11-Mar-2010     -     94,000          -     10,250          56%

     26-Mar-2010     -     63,000          -     10,200          23%

     12-Apr-2010     -     39,000          -     10,900          60%

     26-Apr-2010     -     77,000          -     9,750          54%

     31-May-2010     -     60,000          -     9,150          53%



     From 03-Jun-2010, we switched to Wysolone(15mg) + Pan(40mg) + Folvite(5mg) + Cipcal(500mg) + Neurobion Forte



combination. Platelet details:



Date of CBC     -     Platelet count     -Wysolone-     Haemoglobin     -     Leucocytes     -     Neutrophil



18-Jun-2010     -     66,000          -15mg     -     12.0gms/dl     -     12,200          -     35%

13-Jul-2010     -     report missing     -10mg     -     report missing     -     report missing     -     missing

02-Aug-2010     -     1,00,000     -5mg     -     12.8gms/dl     -     7,400          -     68%

07-Sep-2010     -     51,000          -5mg(A)     -     12.2gms/dl     -     7,450          -     52%

27-Sep-2010     -     29,000          -15mg     -     11.6gmd/dl     -     8,700          -     70%

12-Oct-2010     -     1,02,000     -10mg     -     10.7gms/dl     -     9,000          -     76%

01-Nov-2010     -     80,000          -5mg     -     9.9gms/dl     -     9,300          -     58%

18-Nov-2010     -     76,000          -5mg     -     9.9gms/dl     -     8,400          -     66%

09-Dec-2010     -     75,000          -5mg     -     11.5gms/dl     -     6,350          -     69%





(A)- Alternate days

Wysolone dosage mentioned, prescribed from previous session





Some more details:

------------------

1) Menstruation was 3-4/30 days, regular always upto last year. Irregular periods for past one year. It has stopped



in August-2010.

2) Ocassional giant platelets were reported in two of the several CBC reports.





Medical history beyond one year:

--------------------------------

1) Ocassionally High BP. No medication before hospitalization.

2) Had habit of taking Antipyretics(mostly Crocin during cold, caugh, headaches and fever), Antibiotics(for cold and



caugh) & antacid ( accompanying the antibiotics and Antipyretics) without prescription (based on old prescriptions.

3) 20 Years ago a small fibroid was discovered in the exterior of Uterus. No medication was needed. Confirmed as



vanished in test taken after two years.

4) No diabetes.





Thanks & Regards