Main menu


Case Study (1)- Immune Thrombocytopenic Purpura (ITP)

Case Study (1)- Immune Thrombocytopenic Purpura (ITP)


- 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/L

HGB 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.
Immune thrombocytopenic purpura - perioheral blood smear

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.
Immune thrombocytopenic purpura - Bone marrow

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).


Immune thrombocytopenic purpura (ITP)

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.