Elective splenectomy has been scheduled for a 60-year-old man with severe idiopathic thrombocytopenic purpura (ITP) that has responded poorly to treatment. His current platelet count ranges from 5000/uL to 10,000/uL despite several months of aggressive therapy, including 2 courses of high-dose corticosteroids and 2 courses of intravenous immunoglobulin. The patient has no history of congestive heart failure (CHF), angina pectoris, ischemic heart disease, diabetes mellitus, or stroke. He does have severe degenerative joint disease (DJD) in his knees, which precludes stair climbing and limits his ability to walk long distances. Before ITP was diagnosed, he used NSAIDs; but he currently takes only acetaminophen for symptom relief. A careful review of systems confirms the absence of symptoms of either ischemic heart disease or CHF.
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