In children, acute immune thrombocytopenic purpura (ITP) is often preceded by a viral infection, such as varicella. Patients with ITP present with petechial hemorrhage, mucosal bleeding, and thrombocytopenia with counts often lower than 20,000uL. The peripheral blood smear shows large platelets and no other abnormal cells (such as blasts, which would ac-company childhood leukemia); the bone marrow demonstrates increased, or occasionally normal, numbers of megakary-ocytes. The diagnosis of ITP is partly made by exclusion; fever organomegaly, pancytopenia, lymphadenopathy, or ab-normal peripheral blood cells should prompt an evaluation for malignant disease, such as leukemia, neuroblastoma, or Wilms' tumor, or other nonmalignant bone marrow disorders. Laboratory tests may complement the clinical evaluation, but they are not required to make the diagnosis of ITP. These in-clude the demonstration of an increased percentage of reticulat-ed platelets in the peripheral blood or the detection of platelet autoantibodies in serum or on the platelet (platelet-associated immunoglobulin). However, assays of platelet-associated anti-bodies are not specific for ITP, because immunoglobulins that bind nonspecifically to platelets are often increased in patients with thrombocytopenia secondary to other causes. Techniques that measure specific platelet glycoprotein reactivity of anti-bodies hold greater promise for diagnostic use. An increase in mean platelet volume is also a relatively insensitive and nonspe-cific indicator of destructive thrombocytopenia, in part because of the wide range of normal values.
Diagnosis in Traditional Chinese Medicine
In traditional Chinese medicine, immune thrombocy-topenic purpura is categorized as "ji niu", "fa ban", etc.
The disease can be divided into acute type and chronic type according to the clinical manifestations and courses.
1. Acute type of. chrombocytopenic purpura is commonly found in adolescents. In most cases, the patients have a previ-ous history of viral infection. The onset of the disease is sud-den, manifested as chill, fever and obvious hemorrhage in skin and mucosa. Chronic type of the disease is often seen in fe-males. The onset is slow with mild symptoms. There may ap-pear alternation of attack and remission in a certain period.
2. Physical examination of acute type reveals no particular signs but infection and hemorrhage, while in chronic type which is recurrent in attack, spelenomegaly may be the only finding.
Differentiation and Treatment of Common Syndromes in Traditional Chinese Medicine
1. Bleeding due to Blood-heat:
Clinical manifestations: Sudden onset with fever, purple and deep-coloured purpuras which are great in quantities and in stretches or epistaxis and hematuria with bright colour, flushed face, irritability, deep-red tongue with dry and yellow-ish fur, slippery and rapid pulse.
Therapeutic method: Clearing away pathogenic heat and toxic materials, cooling blood to stop bleeding.
Recipe: Decoction of Rhinoceros Horn and Rehrnannia with additional ingredients.
Ingredients:
Cornu Rhinocerotis lg (ground)
Or Cornu Bubali 3g (decocted prior to others)
Radix Rehmanniae 20g
Radix Paeoniae Rubra 10g
Cortex Moutan Radicis 10g
Radix Scrophulariae 10g
Radix Arnebiae seu Lithospermi 12g
Fructus Forsythiae 15g
Herba Cephalanoploris 30g
Administration: All the above drugs, except Cornu Rhinocerotis which is to be mixed with the finished decoction, are to be decocted in water for oral administration.
Modification: In addition to the above drugs, for treating cases with profuse bleeding, add
Radix Rubiae 30g
Herba Agrimoniae 15g
For cases with thirst and fondness for cold drink, add
Gypsum Fibrosum 10g
Rhizoma Anemarrhenae 30g
For cases with restlessness and constipation, add
Radix et Rhizoma Rhei 6g (decocted later)
