Case Study#3

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A/P:

• Thrombocytopenia - Recurrent ITP appears most likely, no evidence for TTP (no schistocytes or hemolysis), no drugs likely to suppress megakaryocytes, no clear signs of collagen vascular disease or neoplasia.
  
  
• The PMH of ITP makes recurrence probably #1 but the history of recurrent infection and decreased immunoglobulins is worrisome for immunodeficiency.
  
  
• Rx: IVIG, 400mg/Kg x 5d, Solu-Medrol, 80 mg
  
  
• Thrombocytopenic risk for major bleeding, reverse Coumadin with Vitamin K
  
  
• Further lab testing:
  • Ig quantification
  • DIC evaluation
  • antiplatelet antibodies
  • reticulated platelet count
  • CRYO, SPEP, UPEP
  • accessory spleen
  • bone marrow examination