Case Study (1)- Immune Thrombocytopenic Purpura (ITP)
History:
- 11-year-old male. Presented in the emergency room with a recent onset of easy bruising, bleeding gums, and persistent epistaxis.- Previously in excellent health.
- The mother stated he was "never sick before in his entire life."
- No history of recent viral infection, and no family history of bleeding disorders.
Physical Examination:
- Bleeding from the left nostril. Numerous petechiae and purpura; mostly on the extremities.- No organomegaly.
Laboratory Investigations:
1. CBC:(with microscopic differential)
RBC 4.52 x 1012/LHGB 13.4 g/dL
HCT 37.2 %
MCV 82.3 fL
MCH 29.6 pg
MCHC 35.9 g/dL
RDW 12.1
WBC 5.3 x 109/L
N 44 %
L 39 %
M 14 %
E 1 %
B 2%
PLT <5 x 109/L
MPV 10.9 fL
Morphologic Alterations
Results of the blood smear exam were:RBC morphology: Normocytic, normochromic
WBC morphology: Within normal limits
PLT morphology: Appear increased in size.
2. Bone marrow examination:
Aspirate: Erythrocyte and granulocyte maturation within normal limits. Megakaryocytes appear normal in number and morphology.Biopsy: Slightly hypocellular for his age, with abundant megakaryocytes.
3. Coagulation tests:
INR 0.91 (RI 0.85-1.15) PTT 24.8 sec (RI 23-34) TT 15.8 sec (RI 13-18).Diagnosis:
Immune thrombocytopenic purpura (ITP)
Because the patient's ITP was refractory to treatment, it was decided to perform a splenectomy. During the procedure, he received several units of platelets and tolerated the surgery well.
His platelet counts gradually recovered; after six months it was 289 x 109/L.
He is followed in Hematology Clinic and continues to do well.
Clinical Course:
The patient was given standard therapy for ITP for more than a month but failed to respond. His platelet counts did not improve, and he continued to have severe nosebleeds.Because the patient's ITP was refractory to treatment, it was decided to perform a splenectomy. During the procedure, he received several units of platelets and tolerated the surgery well.
His platelet counts gradually recovered; after six months it was 289 x 109/L.
He is followed in Hematology Clinic and continues to do well.
- Immune Thrombocytopenic Purpura (ITP) History: - 11-year-old male. Presented in the emergency room with a recent onset of e…){kind=link}
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