hematology student case

1. Hematolog
y case

2. SCENARIO
MOST LIKELY
DIAGNOSIS
ADDITIONAL
INVESTIGATION
MANAGEMENT

3. Clinical
Presentation
 A 2-year-old boy is brought to hospital because
of gum bleeding and hematuria for 2 days.
 One week before admission he was seen in the
clinic for cough and fever

4. Examination
 Afebrile
 Pink Mucous Membranes
 Petechiae evident on the face and abdomen.
 Urine shows frank (gross) hematuria

5. Investigations
 Hb 11.0 g/dl normal adult 13.5-17.5 2year old 10.5-13.5
 WBC 9.5x10^9/L normal adult 4-11 2 year old 5-15.5
 Platelets- 5x10^9/L normal adult 140-400 2 year old 214-483

6. The Most
Likely
Diagnosis
The most likely diagnosis of this child is
IdiopathicThrombocytopenic Purpura (ITP)

7. ITP
Increased destruction of platelets
ITP is categorized as:
Chronic Idiopathic Thrombocytopenic Purpura and
AcuteThrombocytopenic Purpura
 Acute is mostly seen in children, sometimes following
a vaccination or infection.
Most cases caused by nonspecific immune complex
attachments to platelets.

8. ITP
Spontaneous remissions are usual, but 5-10% of cases
can become chronic, lasting more than 6 months
There is a rare risk of cerebral hemorrhaging.

9. ITP
Pathogenesis
Platelet Autoantibodies such as IgG result in the
premature removal of platelets from the circulation by
macrophages of the reticuloendothelial system
Most times, the antibody is directed against the
glycoprotein GP IIb/IIIa or Ib complex.

10. ITP
Pathogenesis
The normal life span of a platelet is 10 days but in ITP it
is reduced to a few hours.
Total megakaryocyte mass and platelet turnover are
increased by 5 times normal

11. ITP
Pathogenesis

12. ITPClinical
Features and
Diagnosis
Petechial Hemorrhage
Easy Bruising
Mucosal bleeding
Epistaxis
Gum
Platelet Count 10-100 x 10^9/L
Normal Hb andWBC unless IDA from blood loss
Total megakaryocyte mass and platelet turnover are
increased by 5 times normal

13. Management
of ITP

14. Additional
Investigations
Blood film- reduced platelets, larger than normal
Bone marrow- megakaryocytes
Tests for specific anti Glycoprotein GPIIb/IIIa or GPIb

15. Management
of ITP
 If there was no hemorrhaging, no treatment would be
necessary.
 This was why the child was sent home for observation after
the initial visit to the clinic for fever and cough.
 Treatment is with steroids and/or intravenous
immunoglobulin to increase platelet count to
30x10^9/L, the threshold for bruising with low
platelets.
 Avoid activities that would cause further trauma or
bruising

16. THANKYOU QUESTIONS?