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      Tratamiento con altas dosis de corticoides de Púrpura Trombocitopénica Inmune en paciente con Diabetes Mellitus y Obesidad Mórbida, un desafío metabólico Translated title: Treatment of Inmune Thrombocytopenic Purpura whit high doses of steroids in patients with Diabetes Mellitus and Morbid Obesity, a metabolic challenge


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          El manejo de la púrpura trombocitopénica inmune con altas dosis de corticoides en pacientes con diabetes mellitus y obesidad mórbida no está definido. Mujer de 64 años con obesidad mórbida, diabetes mellitus 2 y púrpura trombocitopénico inmune presenta trombocitopenia severa de 2 000 plaquetas asociada a equimosis extensas en ambas extremidades inferiores y glicemia descompensada. Se inició tratamiento con Metilprednisolona 500mg por tres días y luego Prednisona 60mg/día, al quinto día se aumentó dosis a 1 1 0mg/día. Se usó Metformina (850mg, tres veces al día), insulina NPH e insulina cristalina, logrando pasar de una glicemia capilar promedio de 322mg/ dl (primer día) a 122mg/dl (decimotercer día). Al decimocuarto día, con 86 000 plaquetas, fue dada de alta con tratamiento vía oral y control en policlínico. Se logró compensación metabólica con altas dosis de insulina NPH y Metformina. Es posible usar altas dosis de corticoides en pacientes con diabetes mellitus 2 y obesidad mórbida.

          Translated abstract

          The immune thrombocytopenic purpura management with high doses of corticosteroids in patients with diabetes mellitus and morbid obesity is not defined.A 64 years old woman with morbid obesity, type 2 diabetes mellitus and immune thrombocytopenic purpura, presents sever thrombocytopenia with 2000 platelets, associated to extensive bruising in both legs and decompensate glucose. It was treated with Methylprednisolone 500 mg for three days and then Prednisone 60 mg/day, at the fifth day the dose was increased to 110 mg/day. Metformin was used (859 mg/ three times daily), NPH insulin and crystalline insulin achieving an average capillary glycemia of 322 mg/dl (first day) and 122 mg/dl (thirteenth day). At the fourteenth day with a recount of 86000 platelets she was discharged with oral treatment and clinical control. Metabolic compensation was achieved with high doses of NPH insulin and Metformin. It is possible to use high doses of corticosteroids in patients with type 2 diabetes mellitus and morbid obesity.

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          Most cited references16

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          International consensus report on the investigation and management of primary immune thrombocytopenia.

          Previously published guidelines for the diagnosis and management of primary immune thrombocytopenia (ITP) require updating largely due to the introduction of new classes of therapeutic agents, and a greater understanding of the disease pathophysiology. However, treatment-related decisions still remain principally dependent on clinical expertise or patient preference rather than high-quality clinical trial evidence. This consensus document aims to report on new data and provide consensus-based recommendations relating to diagnosis and treatment of ITP in adults, in children, and during pregnancy. The inclusion of summary tables within this document, supported by information tables in the online appendices, is intended to aid in clinical decision making.
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            Immune thrombocytopenic purpura.

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              The ITP syndrome: pathogenic and clinical diversity.

              Immune thrombocytopenia (ITP) is mediated by platelet autoantibodies that accelerate platelet destruction and inhibit their production. Most cases are considered idiopathic, whereas others are secondary to coexisting conditions. Insights from secondary forms suggest that the proclivity to develop platelet-reactive antibodies arises through diverse mechanisms. Variability in natural history and response to therapy suggests that primary ITP is also heterogeneous. Certain cases may be secondary to persistent, sometimes inapparent, infections, accompanied by coexisting antibodies that influence outcome. Alternatively, underlying immune deficiencies may emerge. In addition, environmental and genetic factors may impact platelet turnover, propensity to bleed, and response to ITP-directed therapy. We review the pathophysiology of several common secondary forms of ITP. We suggest that primary ITP is also best thought of as an autoimmune syndrome. Better understanding of pathogenesis and tolerance checkpoint defects leading to autoantibody formation may facilitate patient-specific approaches to diagnosis and management.

                Author and article information

                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Revista Científica Ciencia Médica
                Rev Cient Cienc Méd
                Facultad de Medicina, Universidad Mayor de San Simón. (Cochabamba, Cochabamba, Bolivia )
                : 15
                : 1
                : 41-43
                [03] Chillán orgnameHospital Clínico Herminda Martin Chile
                [01] Chillán orgnameUniversidad Católica de la Santísima Concepción Chile

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                : 26 August 2012
                : 08 July 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 3

                SciELO Bolivia

                Púrpura Trombocitopénica Idiopática,Diabetes Mellitus tipo 2,Obesidad Mórbida,Idiopathic Thrombocytopenic Purpura,Diabetes Mellitus Type 2,Morbid Obesity


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