Monday, September 23, 2013

Thrombotic Thrombocytopenic purpura and pregnancy

Recently have started to spend less time with blogs.Realized recently that net has many fold reach
than what I used to imagine.Few Australian doctors  were communicating with me on phone.And their 99 % discussion was related to my blog posts.I was amazed as well as amused.
But then it made me understand that whetever I write should be a responsible comment/statement and even if I am not feeling too good about something,better to avoid writing it if it is controversial.

Life is as usual.So is work.Nothing new really to share.

Let us talk about a very rare condition TTP or thrombotic Thrombocytopenic purpura.It is very rare condition which can happen in women after pregnancy.Suddenly the blood cells start getting haemolysed,platelets are cosumed which gives patchy appearance to the person,Kidney and liver shuts down and a person can be quite sick with this condition.Even immunity gets compromised.The medicines associated with it are Contraceptive pills,blood thinners ,cholesterol lowering simvastatin,quinine and few cancer medication like beomycin.mitomycin etc.

Almost 25 % TTP are caused by pregnancy and other who are prone to it are those who are immunocompromised,have H/O HIV

Having said that don't get scared of either pregnancy or  taking these drugs if indicated.IT is a very rare condition which if not treated leads to the death of the Lady.

It's simple treatment is a procedure called plasmapheresis  .

Goes without saying-------- a patient of mine had this rare condition which is as rare as 6 in 1000000 !! 

Wednesday, September 4, 2013

One Medicine but multifactorial uses

 let me talk about medicines which originally was invented for a different reason and now is being for used for treatment various unrelated condition.
Let us start with the Cancer drug METHOTREXATE. Given to patients with choriocarcinoma and not fibroid as some one very erroneously wrote some where very recently.
The another very important use of Methotrexate is helping both unmarried as well as married women with ectopic pregnancy which otherwise can kill them if undetected and ruptures. The dose recommended is 50 mg/m2 which means for a 5 feet 1 inch female with 65 kgs the dose would be around 82.5 mgs. It is a small dose therapy unlike high dose therapy used for cancers in the dose of 500 mgs/m2.You would expect hair fall, mouth ulcers, patches, bone marrow suppression at high dose but  at 50 mg/m2 it is quite safe medicine recommended by RCOG and ACOG. One would be really unlucky to be sensitive to such a minuscule dose of such a wonderful 'cancer' medicine.

Another one is metformin. It was and is used for Type II Diabetics but with equal vigour it is being used in women with PCOD and that doesn't make them diabetic.

Oral contraceptive pills are used for treating various hormonal imbalance apart for contraception.

Vit B complex is a supplement but at times in patient's with recurrent miscarriage and homocysteinuria it becomes the treatment.