Case Presentation – Hematology 4

History

A 34 year old female presents to the clinic with complaints of easy bruising and prolonged bleeding from minor cuts over the past month. She also reports occasional episodes of nosebleeds and heavy menstrual periods. There is no significant past medical history, and she is not on any medications. She denies any recent infections or vaccinations

Examination

On physical examination, the patient appears well and is in no acute distress. Vital signs are within normal limits.

Physical Examination Findings:

  • Vital Signs: BP 120/80 mmHg, HR 76 bpm, RR 16 breaths/min, Temp 98.6°F
  • Skin: Multiple ecchymoses on the arms and legs, petechiae on the lower extremities
  • HEENT: Mild epistaxis noted, no lymphadenopathy
  • Cardiovascular: Normal S1 and S2, no murmurs
  • Abdomen: Soft, non-tender, no hepatosplenomegaly
  • Neurological: Normal reflexes and sensory examination

Laboratory Investigations

Initial laboratory tests are performed to evaluate the patient’s condition.

Laboratory Results:

  • Complete Blood Count (CBC):
    • Hemoglobin: 13.2 g/dL (normal: 12-16 g/dL)
    • White Blood Cells: 7,000/μL (normal: 4,000-11,000/μL)
    • Platelets: 25,000/μL (normal: 150,000-450,000/μL)
  • Peripheral Blood Smear:
    • Few large platelets noted, no schistocytes or other abnormalities
  • Coagulation Profile:
    • Prothrombin Time (PT): 12 seconds (normal: 11-13.5 seconds)
    • Activated Partial Thromboplastin Time (aPTT): 30 seconds (normal: 25-35 seconds)
  • Liver Function Tests:
    • ALT: 22 U/L (normal: 7-56 U/L)
    • AST: 20 U/L (normal: 10-40 U/L)
  • Renal Function Tests:
    • Creatinine: 0.8 mg/dL (normal: 0.6-1.2 mg/dL)
    • BUN: 14 mg/dL (normal: 7-20 mg/dL)

Differential Diagnoses

Several conditions can present with thrombocytopenia and must be considered before making a definitive diagnosis.

Potential Differential Diagnoses:

  1. Drug-Induced Thrombocytopenia: The patient is not on any medications, making this less likely.
  2. Bone Marrow Disorders: The normal white blood cell count and absence of anemia reduce the likelihood of conditions like leukemia or myelodysplastic syndromes.
  3. Viral Infections: No recent history of infections, and normal liver function tests rule out hepatitis and other viral causes.
  4. Systemic Lupus Erythematosus (SLE): No signs of systemic involvement such as arthritis, skin rashes, or renal impairment.
  5. Thrombotic Thrombocytopenic Purpura (TTP): No neurological symptoms or evidence of hemolysis on the blood smear.

Final Diagnosis

Based on the clinical presentation, physical examination, and laboratory findings, the patient is diagnosed with Immune Thrombocytopenic Purpura (ITP). The key features supporting this diagnosis are isolated thrombocytopenia with a platelet count of 25,000/μL, absence of other hematologic abnormalities, and normal coagulation studies.

Diagnostic Criteria for ITP:

  • Isolated thrombocytopenia (platelet count < 100,000/μL)
  • Absence of other causes of thrombocytopenia
  • Normal peripheral blood smear without evidence of hemolysis

Conclusion

This case illustrates a typical presentation of ITP in an otherwise healthy young woman with unexplained bruising and bleeding. The diagnosis was confirmed through clinical evaluation and exclusion of other potential causes of thrombocytopenia. Management of ITP typically involves corticosteroids, and in refractory cases, additional treatments such as intravenous immunoglobulin (IVIG) or splenectomy may be considered. Regular follow-up is essential to monitor platelet counts and assess response to treatment.

Next Case

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top
Modern HealthMe