My 9-month-old son is suffering from low platelet count. Please help.

Question

Hi doctor,

My son is 9 months old. He had a high fever and low platelet count (70000 per microliter of blood). We admitted him immediately and done blood platelet transfusion (100 ml). The next day, the platelets went down to 16000 per microliter of blood. He was discharged from the hospital when it came up to 95000 per microliter of blood. Now after a week, the count went down to 52000 per microliter of blood again. My pediatrician suggested taking advice from hematologist to see if he requires treatment for ITP (if diagnosed as such). Please advice next steps, worrying a lot. I also had this problem when I was two and a half years old. I was given steroids as a treatment.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through the query (attachment removed to protect patient identity). Your son's latest report shows neutrophilia. It is suggestive of bacterial infection. Further workup can be done in the form of CRP (C- reactive protein) estimation, blood culture, and flow cytometry to rule out congenital thrombocytopenia causes. ITP is a diagnosis of exclusion. If there is no other cause found, then only ITP is suspected. For that bone marrow study is essential. Please provide me the previous CBC report also to give further comment.

Answer 2

Hi,

Welcome back to icliniq.com.

Your doctor was right. Initially, your son had a viral fever, and it was managed well symptomatically. Viral fever was diagnosed because the lymphocytes were elevated. But, now total WBC count is high, and neutrophils are elevated. So, bacterial infection should be ruled out. Your child needs examination for liver, spleen and lymph nodes palpation. I suggest investigating with peripheral smear examination report, CRP (C-reactive protein) estimation, blood culture (if needed) report. Peripheral smear examination report will guide your doctor further. If there is no specific cause found, then only bone marrow examination can be planned to rule out ITP (idiopathic thrombocytopenic purpura). Consult a hematologist tomorrow for investigation and discuss all. You can follow back after the hematologist consultation.