Tuesday, November 04, 2014

Spot Diagnosis # 1

A 4-5 years old male child presented with the black spots on his both legs along with bleeding from oral mucosa (as shown in the images below). His hemoglobin level was found to be 12 gm/dl, total leukocyte count 7400/cumm and platelets 51000/cumm. What is your spot diagnosis?


Diagnosis: Idiopathic thrombocytic purpura (ITP)
What is ITP?
ITP is a blood disorder where platelets (a kind of blood cells) are destroyed autoimmunically by the spleen.
What causes ITP?
ITP is caused by antiplatelet autoantibodies, leading to destruction of platelets through the process of phagocytosis.
What are the risk factors of ITP?
Usually it is seen that viral infections precipitate the development of ITP. In its acute form, ITP occurs after two weeks of infection with self-limiting bruises, petechiae and purpura. In its chronic form, it runs an indefinite course of signs and symptoms like bleeding, purpura, bleeding from nose or heavy menstruation.
What are signs and symptoms of ITP?
ITP may present as bleeding from mucus membranes like oral mucosa and tiny hemorrhages or black spots on the body.
Does ITP cause splenomegaly?
Bear in mind, in ITP, there is no splenomegaly.
What tests are carried out in ITP?
Bone marrow examination shows increased number of megakaryocytes in marrow. Antiplatelet autoantibodies may also be seen in the blood. Mild disease may not need any treatment.
How to treat ITP?
If the condition is symptomatic or platelets are below 20000/L, prednisolone 1mg/kg/day should be started (and reduce the dose after remission). The target of the therapy is to keep platelets above 30000/L.
If ITP relapses?
If ITP relapses, splenectomy results in 80% cure. Immunosupression (azathioprine or cyclophosphamide) may be started if the management still fails.
Should we transfuse platelets?
Do not transfuse platelets.
What to do during pregnancy?
Intravenous immunoglobulins may raise platelet count temporarily in conditions such as surgery and pregnancy.
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Keywords: ITP, Diagnosis, Splenomegaly, Haematology, Platelet disorder, Low platelets

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