March Week 4 (by Dr Bidadi)


John is a 6 year old boy previously healthy with a recent URI that was attributed to a virus that now presents to the hospital with easy brusing and a purpuric rash on his extremeties for the last several days. No recent fevers. He otherwise looks well. No hepatosplenomegaly and no lymphadenopathy. Bruises are generalized and not attributed to trauma. Labs reveal marked thrombocytopenia with platelets of 15,000. Labs are otherwise normal. 
1. How is itp classified?
2. What is the key element of pathophysiology of itp? 
3. What are the clinical manifestations of itp?
4. What is the diagnostic workup for itp?
5. What is In the differential diagnosis for itp.
6. When should you do a bone marrow biopsy?
7. What is the management of itp? 
Melissa is a 15 year old girl with recent history of several months of joint pains intermittent fevers with the finding of chronic thrombocytopenia for more than 6 months.
1. What kind of workup would you do for this patient with chronic ITP? 
2. What is in the differential diagnosis for chronic ITP? 
3. What is the management? 
A 4 month old presents to the emergency department with a history of hemangioendothelioma with easy bruising and petechia over the last 2 days. This patient is found to have severe thrombocytopenia (platelet count of 6000) with a mild coagulopathy (prolonged pt and ptt)
1. What is the etiology of this patients bleeding disordeR?
2. What is the differential diagnosis of patients with congenital thrombocytopenia?