Idiopathic thrombocytopenic purpura
An 8-year-old child is admitted with severe epistaxis. She has a generalized purple petechial rash that developed over the last 24 hours. She also has hemorrhage bullae on her gums and lips. Her parents state that “she just started to bleed before our eyes. ” She denies any recent injuries. Her parents report that she just got over a bad cold. Her lab work shows abnormal bleeding time, thrombocytopenia, normal granulocytes, and low normal hemoglobin and hematocrit. What type of disorder does this child have, and what is the pathophysiology?
The child is suffering from Idiopathic thrombocytopenic purpura (ITP) which is a clotting disorder that develops from an immune problem, leading to a drop in the platelet clot and resulting in excessive bleeding, bruising, skin rashes, etc. The disorder can affect both children and adults, although in children it can develop following a viral infection such as a common cold. However, children tend to recover fast, and it may be benign (gets better within a few weeks).
The other characteristic symptoms of ITP include nose bleeds, petechia (pinhead sized spots on the skin), prolonged bleeding following trauma, gum bleeding, presence of blood in urine or stools, spontaneous bleeding without a visible cause (in severe cases), etc. In some cases, bleeding may be serious and may occur in the internal organs, requiring emergency medical care (Mayo, 2010). The precise cause of ITP is not known clearly, although it develops from any immune dysfunction.
The viral antibodies (that are produced against a viral infection) tend to destroy the platelets present in the body, resulting in a drop in the platelet count. The antibodies tag themselves to the platelets and the spleen identifies these platelets as foreign bodies, removes them from circulation and destroys them. The usual platelet count is 150,000 to 450,000 cells/micro liter of blood, but the risk is huge when the platelet count drops below 10,000, when spontaneous bleeding occurs. ITP can also occur following a bout of measles, mumps, or other respiratory tract infection.
It tends to occur more often in girls compared to boys, but in older adults and elders, the male-female ratio is almost equal (Mayo, 2010). The diagnosis of ITP is made on the history, signs, symptoms, family history, blood tests, and bone marrow examination. The complete blood count demonstrates a drop in the platelet count; with a normal or a slightly lower WBC count, RBC count and hemoglobin. The coagulation time including partial thromboplastin time (PTT) and prothrombin time (PT) are normal.
Bleeding time may be increased, and antibodies against platelets are detected in the blood (Wrong Diagnosis, 2010). References Mayo Clinic (2010). Idiopathic thromobocytopenic purpura (ITP), Retrieved on June 7, 2010, from Web site: http://www. mayoclinic. com/health/idiopathic-thrombocytopenic-purpura/DS00844 Wrong Diagnosis (2010). Diagnostic Tests for Immune Thrombocytopenic Purpura, Retrieved on June 7, 2010, from Web site: http://www. wrongdiagnosis. com/i/immune_thrombocytopenic_purpura/tests. htm
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