Dr. Mubashir Razzaq Khan
Hematology
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Patient's Query
Hi,
My son is seven years 11 months old baby and weighs 52 lbs. Ten weeks back, he was sick with a high fever for three days. After three weeks from that, he got bruises and bleeding in his nose. They saw his platelet level was very low (2000) and identified as ITP (Idiopathic thrombocytopenic purpura). They gave IVIG and saw platelets increasing. In two week checkup after IVIG, platelets count was 109000. Six weeks after IVIG, when we checked, it was 112000. There has been no increase for the last four weeks.
1. Any possible reason why his platelets are not increasing now? What type of tests we can do to diagnose further?
2. Last two years, his weight percentile dropped from 60 to 30 in three months after when he was sick once with a fever for a couple of days. Not sure if it is a coincidence, but a few weeks before, he put his hand in his mouth with some blood stains from somewhere he touched in the park. It happened before we could notice and stop. He fell sick after two weeks. From that time onwards, for the last two years, he has been feeling weak and in the weight 25 percentile range even though he is eating a lot more. His knee also showed a clicking sound in his joint last year, as we hear for many people after 60 years of age. Can there be some chronic viral, bacterial, or parasite infection that could trigger ITP (Idiopathic thrombocytopenic purpura), weakness, and weight loss? Please tell me all possible infections that could trigger we can test even though it is rare.
3. I read that some chronic infections could trigger ITP (Idiopathic thrombocytopenic purpura). In those cases, would that trigger ITP (Idiopathic thrombocytopenic purpura) in a few months, or could it trigger two years also? Please help with all questions since we cannot get much input regarding ITP (Idiopathic thrombocytopenic purpura).
Hi,
Welcome to icliniq.com.
ITP (idiopathic thrombocytopenic purpura) is the idiopathic (immune) mediated destruction of platelets. There is no defects or deficiency in platelet formation. It is frequently associated with a prior fever (most likely due to viral infections).
Let us go with your questions, point to point.
1- Currently, it is grade 1 thrombocytopenia. It is quite a safe level and is nearly normal. Get ANA (antinuclear antibody) by immune fluorescent technique for further evaluation to rule out any systemic autoimmune disorder. No need for treatment or further investigations if ANA (antinuclear antibody) is negative.
2- Weight loss is a non-specific sign. It includes hundreds of medical conditions ranging from nutritional deficiency to cancers. Please upload a full CBC (complete blood count), LFTs (liver function test), RFTs (renal function test), LDH (lactic acid dehydrogenase), and ESR (erythrocyte sedimentation rate) reports to rule out or to go ahead to further investigations. Similarly, knee joint sounds might also be heard in dehydration, vitamin D deficiency, calcium, and phosphate deficiency. According to local guidelines, take plenty of water, vitamin D, calcium, and phosphate.
3- Chronic infections can complicate ITP (idiopathic thrombocytopenic purpura), but these infections have definite signs and symptoms according to the organs and pathogens involved. ITP (idiopathic thrombocytopenic purpura) itself can relapse without any cause.
Build his vitamin B12, folic acid, pyridoxine, iron, and levels. By the way, can you speak Hindi or Urdu?
Patient's Query
Hello doctor,
Thank you for the reply.
We did check his blood work. I am attaching that below. Can you please review that and let us know if all tests required are covered and looks normal? For the last month, he passed stool twice or thrice a day most days and was a little loose. Are there any stool or blood tests that can be done to check for any chronic infection related to parasites, bacteria, or viruses? It is three months from the time he got ITP (immune thrombocytopenic purpura). Also, we see his height has not increased even a centimeter this time, the weight dropped almost a kilogram. Any test can be done to check this or his growth hormone level? Please let us know all possible or advanced tests (stool, blood, urine, or anything else) that we can do related to any chronic pathogen-complicating things (digestion and growth) and tests to check growth. I see some tests like IGF-1 and IGBP-3 are available to check growth hormones. Will that help or is there anything else you suggest? Also, please let us know the next set of tests we can consider after three or six months in case we do not see any improvement. Sorry for asking a lot of questions. We just want to make sure to check thoroughly as he is getting weaker and weaker from the time he accidentally touched some blood in the park and put his hand in his mouth around 2.5 years back.
Thank you.
Hello,
Glad to have you back!
I am here to help you get the best medical advice.
You did not upload any tests. I told you to get a fresh CBC (complete blood count), LFTs (liver function test), RFTs (renal function test), LDH (lactate dehydrogenase), and ESR (erythrocyte sedimentation rate) tests done. For loose stools, build up his zink level first. The weight loss of 2.2 pounds in three months is insignificant. It might be due to loose stools. Three months is too little time to monitor height. There is no need for aggressive testing. A height of four feet at seven years of age is fine. Are there any relatives more than six feet tall? If yes, then four feet is a little short. But you cannot predict now. Build up his vitamin B12, pyridoxine, iron, vitamin D, and folic acid.
Thank you.
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Hematology
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