Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Idiopathic Thrombocytopenic Purpura

idiopathic thrombocytopenic purpura in русский (Россия)

Related Terms

  • Autoimmune Thrombocytopenic Purpura (Primary)
  • Idiopathic Thrombocytopenia
  • Immune Thrombocytopenic Purpura
  • Primary Thrombocytopenia

Differential Diagnosis

  • Acute leukemia
  • Disseminated intravascular coagulopathy (DIC)
  • Drug-induced thrombocytopenia
  • Hemolytic-uremic syndrome (HUS)
  • Human immunodeficiency virus (HIV)
  • Hypersplenism
  • Liver disease
  • Lymphoma
  • Malignancy
  • Myelodysplasia
  • Posttransfusion reaction
  • Pregnancy induced thrombocytopenia
  • Sepsis
  • Systemic lupus erythematosus (SLE)
  • Thrombotic thrombocytopenic purpura (TTP)

Specialists

  • Emergency Medicine Physician
  • General Surgeon
  • Hematologist
  • Immunologist
  • Neurosurgeon
  • Rheumatologist

Comorbid Conditions

  • Blood dyscrasias
  • Hepatic disease
  • Hypertension

Factors Influencing Duration

Length of disability may be influenced by severity of the disease, need for and response to treatment, whether splenectomy is performed, and presence of complications.

Medical Codes

ICD-9-CM:
287.31 - Primary Thrombocytopenia, Immune Thrombocytopenic Purpura; Idiopathic Thrombocytopenic Purpura; Tidal Platelet Dysgenesis

Overview

Idiopathic thrombocytopenic purpura (ITP) is a condition characterized by a low platelet count with no apparent underlying cause. This is in contrast to other occurrences of low platelet counts (thrombocytopenia), in which the deficiency can be attributed to an infection, disease, or drug.

Individuals with this condition have normal, functioning bone marrow, and no systemic illness. Nevertheless, the platelets are destroyed in the circulating blood by the body's own immune system (autoantibodies). Platelets play a vital role in forming blood clots and stopping bleeding. A reduction in the number of platelets causes a tendency to bleed, especially from the smaller vessels. The term "purpura" refers to the bruising and deposits of blood under the skin commonly seen in association with platelet deficiency.

There are two forms of idiopathic thrombocytopenic purpura (ITP). An acute form typically occurs in childhood. A chronic form, defined as lasting longer than 6 months, occurs in adults.

Incidence and Prevalence: In the US, 66 adults per million develop ITP each year (Silverman).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The female to male ratio is 2.6 to 1. The peak incidence of adult ITP occurs in those aged 20 to 50 years.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms typically appear gradually. Individuals will report bruises on the skin, prolonged or heavy menstrual bleeding, nosebleeds, gum bleeding, gastrointestinal bleeding, or blood in their urine. Headache and dizziness may indicate a risk of brain hemorrhage. Often an individual has no symptoms and the condition is discovered unintentionally during a routine examination or while being checked for another medical condition.

Physical exam: The individual may present with small capillary hemorrhages (petechiae) or larger bruises (ecchymoses) under the skin. Hemorrhagic blisters may be present in the mouth. The rest of the exam is normal. An enlarged spleen is an unusual sign and, if present, points to another diagnosis.

Tests: A complete blood count (CBC) will show an abnormally low platelet count, but will otherwise be normal. A bone marrow aspiration and biopsy will reveal normal platelet production, in appearance and in number. Coagulation tests to check platelet function and to look for other clotting abnormalities include bleeding time, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, platelet aggregation, and platelet antibody studies. Additional tests will be performed as needed to rule out other causes of thrombocytopenia, and may include liver function tests, and tests to identify infection such as HIV and ehrlichiosis, and connective tissue disease, such as systemic lupus erythematosus.

Taking into account history, physical, CBC, and bone marrow findings, diagnosis of idiopathic thrombocytopenic purpura is made by excluding other possible causes of the low platelet count.

Source: Medical Disability Advisor



Treatment

Treatment depends on the platelet count and the presence of bleeding. Asymptomatic individuals need only observation and periodic monitoring of the platelet count. General caution, however, dictates that individuals with thrombocytopenia avoid invasive procedures or injury, if possible, and avoid any drug that may affect platelets, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Treatment may be needed only when the individual has had a traumatic injury or is preparing for surgery.

Individuals with very low platelet counts or moderate counts plus bleeding should be treated with immunosuppressant glucocorticoid drugs until counts return to normal. At that time, the glucocorticoids should be gradually tapered off. Additional treatment cycles are often needed to maintain an adequate platelet count.

Individuals with severe bleeding are hospitalized and treated with intravenous glucocorticoids plus high-dose immune globulin (immune globulin increases platelet survival time). If the bleeding is life-threatening, platelet transfusions are also given.

Surgical removal of the spleen (splenectomy) is beneficial for individuals who do not respond to steroid therapy or require unacceptably high doses to maintain adequate platelets. Although in ITP the spleen does not sequester platelets, it does produce the antibodies that attack the platelets. Removing the spleen removes the source of the destructive antibodies.

Source: Medical Disability Advisor



Prognosis

In adults, ITP is typically chronic. Only 2% of adults will have a spontaneous remission (Silverman). Immunosuppressant glucocorticoid treatment usually reduces bleeding within 1 day and raises platelet counts within 1 to 3 weeks. Approximately 80% of individuals with ITP respond to this treatment, but most will relapse once the treatment has stopped and will require additional treatment cycles. Individuals who do not respond to glucocorticoid treatment or who require unacceptably high doses often will benefit from splenectomy. This surgical procedure brings about partial or complete remission in 80% of individuals.

Source: Medical Disability Advisor



Complications

Complications from this disease include acute bleeding into any area of the body, including the brain (intracranial hemorrhage). In fact, intracranial hemorrhage is the main cause of death attributable to ITP, and occurs in 5% of individuals with the condition. Splenectomy is associated with an increased susceptibility to infection.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals who have significantly decreased platelet counts need a safe work environment, avoiding the risk of personal injury, which could trigger an acute bleed. Where indicated, protective gear, especially for the head, should be worn. Office work or sedentary work would probably be more appropriate than strenuous work involving heavy lifting or other physical exertion. The employer should be aware of the condition so that the appropriate level of care can be quickly provided in the event of an on-the-job injury. Once the individual's platelet counts have returned to normal, no work restrictions should be needed. Time off will be needed if splenectomy or hospitalization is required.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has an underlying cause of idiopathic thrombocytopenic purpura (ITP) been identified?
  • Have conditions with similar symptoms been ruled out?
  • Has individual experienced any complications related to the idiopathic thrombocytopenic purpura?
  • Does individual have a coexisting condition that may impact recovery?
  • If pregnant, are there drugs that the individual may safely use?

Regarding treatment:

  • Are individual's platelet counts periodically monitored?
  • Is treatment currently being sought due to a traumatic injury or in preparation for surgery?
  • If the bleeding was life-threatening, were platelet transfusions also given?
  • Has treatment sufficiently raised platelet count for this purpose? If not, what else can be done?
  • Has individual responded to immunosuppressant therapy?
  • Are the doses required to maintain adequate platelet counts intolerable?

Regarding prognosis:

  • If individual does not respond to glucocorticoid treatment or requires unacceptably high doses, is individual a candidate for a splenectomy?
  • Is individual aware that he or she needs to avoid the risk of personal injury, which could trigger an acute bleed?
  • Does individual continue to participate in activities that are high- risk for bodily injury, particularly to the head? If so, does the individual wear protective gear, such as a helmet?

Source: Medical Disability Advisor



References

Cited

Silverman, Michael. "Idiopathic Thrombocytopenic Purpura." eMedicine. Eds. Edward A. Michelson, et al. 17 Sep. 2004. Medscape. 22 Dec. 2004 <http://emedicine.com/emerg/topic282.htm>.

Source: Medical Disability Advisor






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