I need a second opinion regarding ITP. Please help me.

Hello,

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Isolated low platelet count with normal hemoglobin and CBC (complete blood count) usually is the key laboratory finding for ITP (idiopathic thrombocytopenic purpura) as there in this case. It is the diagnosis of exclusion, however. I need a few more details about his medical history.

1. Did he ever have gingival bleeding, epistaxis (nose bleeding), or any spontaneous bruising?
2. Any history of dark foul-smelling stools or melena?
3. Is there evidence of viral illness like fever or diarrhea or upper respiratory tract infection?
4. Does he have any splenomegaly?

ITP is the primary immune-mediated destruction of platelets by self-generated antibodies to platelets. It is of two types, acute and chronic. Acute ITP usually follows infection and has a spontaneous resolution in eight weeks or two months. Chronic ITP persists longer than six months without any cause.

Management includes conservative and observation alone for the ones who do not have any signs of bleeding or mild cutaneous manifestations as in this case. In case of any bleeding or life-threatening complications, I order to suppress immune-mediated destruction of platelets which will require IV immunoglobulin, Methylprednisolone, and platelet transfusion. As of now he can be managed conservatively and continuous watch on bleeding manifestations should be followed. If the condition persists for more than six months that is if it progresses to chronic ITP then drugs like Eltrombopag and Nplate - Romiplostim can be tried to stimulate platelet production for the one who experiences inadequate response to steroids. Now platelet count and bleeding manifestations are to be continuously monitored till it reaches normal and the Prednisone dose should be tapered to avoid long term complications of corticosteroids. As I said do watch for bleeding manifestations like large spontaneous bruises, melena, gingival bleeds, gastrointestinal bleeding, altered sensorium and confusion. Do not let him play as falls may lead to hematomas and internal bleeds. Do not worry. In most cases, it resolves spontaneously.