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Teaching Cases

Thrombocytopenia – Terry Gernsheimer, MD, and Michele B. Frank, MD
Dr. Gernsheimer: Puget Sound Blood Center and University of Washington School of Medicine, Seattle, WA; Dr. Frank: Cascade Cancer Center, Kirkland, WA

Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.


I. HistoryII. Physical ExamIII. Laboratory DataIV. Pathophysiology
V. Differential DiagnosisVI. Prognosis/Clinical CourseVII. Teaching PointsVIII. Bibliography

VI. PROGNOSIS/CLINICAL COURSE

You order liver function tests to screen for hepatitis or other liver disease, and an HIV screen. The results will be available in two weeks.

What are the best treatment options for the interim? (Choose all that apply.)
NOTE: This patient is 23-year-old, and therefore falls into the category of adult ITP. Childhood ITP remits spontaneously 90% of the time, and treatment should be limited only to children with severe bleeding symptoms.

Platelet transfusion
Prednisone
Intravenous immune globulin (IV IgG) and prednisone
Anti-RhD immunoglobulin (WinRho) and prednisone.
Cyclophosphamide
Splenectomy
Plasmapheresis


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