A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and "funny looking red splotches" on her legs. These bruises were first noticed about 2 weeks ago and are not related to trauma. PMH not remarkable and she takes no medications. The mother does state the girl is recovering from a "bad case of mono" and was on bedrest at home for the past 3 weeks. The girl noticed that her gums were slightly bleeding when she brushed her teeth that morning.

Labs at urgent care demonstrated normal hgb and hct with normal WBC differential. Platelet count of 100,000/mm3 was the only abnormal finding. The staff also noticed that the venipuncture site oozed for a few minutes after pressure was released. The doctor at urgent care referred the patient and her mother to the ED for a complete work-up of the low platelet count, including a peripheral blood smear for suspected immune thrombocytopenia purpura.

Question:

1. The factors that affect fertility (STDs).
2. Why inflammatory markers rise in STD/PID.
3. Why prostatitis and infection happens. Also explain the causes of systemic reaction.
4. Why a patient would need a splenectomy after a diagnosis of ITP.
5. Anemia and the different kinds of anemia (i.e., micro and macrocytic).

Answer:

1.The factors that affect fertility (STDs).

Answer:

• Post cance
• irregular periods
• smoking & drinking
• hiatory of STDs
• age
• obesity

2.Why inflammatory markers rise in STD/PID.

Answer: Inflammatory matkers rise in STD/PUD because it is the body's innate respose to injury or insult. STD/PID is associated with increased level of inflammatory markers, such as CA-125, ESR and CRP, incidence of TOA, operation risk, and longer hospitalization.

3.Why prostatitis and infection happens. Also explain the causes of systemic reaction.

Answer: Prostatitis start when bacteria in urine leak into postate. Bacterial prostatitis is most often caused by uropathogens, mainly Gram-negative bacilli. But Gram-positive and atypical microorganisms have also been identified as causative organisms of chronic prostatitis. Chlamydia trachomatis and Trichomonas vaginalis are among common pathogens, making chronic prostatitis a sexually transmitted disease.

4.Why a patient would need a splenectomy after a diagnosis of ITP.

Answer: In people with ITP the immune system treats platelets as foreign and destroys them. The spleen is responsible for removing these damaged platelets and therefore removal of the spleen can help to keep more platelets circulating in the body. Splenectomy used to be the standard treatment for ITP before drug therapies were developed, and it is still carried out in patients with chronic severe ITP (troublesome ITP for a year or more).

5.Anemia and the different kinds of anemia (i.e., micro and macrocytic).

Answer:

Microcytic

• iron deficiency IDA
• Chronic infections
• thalassemia
• hemoglobinopathies
• sideroblastic anemia

Macrocytic

• megaloblastic anemias
• liver disease/alcohol
• hemoglobinopathies
• metabolic diaorders
• marrow disorders
• increased destruction