Download 100 Cases in Clinical Medicine by John Rees, James Pattison, Gwyn Williams PDF

By John Rees, James Pattison, Gwyn Williams

This article covers center fabric in medical medication. protecting the most important structures in 15 sections, every one part comprises 8 instances. those circumstances replicate these which scholars and residence officials will meet in outpatients and normal perform. hide; booklet name; Contents; Preface; Acknowledgements; Abbreviations; part 1: Systems-related situations; part 2: common self-assessment circumstances; Index

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Platelet consumption is increased in disseminated intravascular coagulation and thrombotic thrombocytopenic purpura (TTP). The patient should be immediately referred to a haematology unit. Platelet transfusion is usually given if there is significant bleeding or the platelet count is less than 15 ϫ 109/L to prevent a major spontaneous bleed. Investigations include assaying for platelet-associated immunoglobulin G (IgG), excluding other causes of thrombocytopenia such as SLE and performing a bone marrow aspirate.

In addition to the purpuric lesions in the skin there may be menorrhagia, epistaxes or occult or overt gastrointestinal haemorrhage. In this woman’s case there is a mild normochromic normocytic anaemia due to recent blood loss. Splenomegaly is usually absent. The causes of thrombocytopenia can be divided into disorders of reduced production of platelets or decreased survival of platelets. g. g. cytomegalovirus [CMV]). Platelet survival is reduced in ITP due to antibodies directed against the platelets.

Treatment depends on the likely resistance pattern in the area visited and up-to-date advice can be obtained by telephone from microbiology departments or tropical disease hospitals. Falciparum malaria is usually treated with quinine sulphate because of widespread resistance to chloroquine. A single dose of Fansidar (pyrimethamine and sulfadoxine) is given at the end of the quinine course for final eradication of parasites. However there is increasing resistance to quinine, and artemesinin derivatives are increasingly becoming the first-line treatment for falciparum malaria.

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