A 3 year old female child presents to the Emergency Department with her foster father. The child had a recent upper respiratory tract infection 14 days ago and now has a 3 day history of bruising. The child has not had gum bleeding. There is no past history of bleeding nor bruising.
On exam, the child looks well, actively running around the room. Vitals as listed.
Head and neck exams are normal. There are no adventitious breath sounds. Cardiac exam is normal. The skin exam shows 1 mm diameter, non-blanching, red spots scattered diffusely and small bruises over the arms and legs. There is no adenopathy, no hepatosplenomegaly and all joints are normal.
Lab work
CBC - WBC 8.8 x109/L (Normal range: 6-14 10E9/L)
Hemoglobin 120 g/L (Normal range: 100-150 g/L)
Platelets 4 x 109/L. (Normal range: 150-400 10E9/L)
INR 1.0 (Normal range: 0.9-1.1)
PTT 30 seconds. (Normal range: 27.0-37.0 seconds)
Patient presentation of isolated thrombocytopenia usually post upper respiratory tract infection is classic. Treatment is dependent on patient presentation and age. If the child is older and not actively bleeding, serial monitoring of CBCs is all that is required. In the younger child or someone with active bleeding, consideration of IVIG or steroids is indicated.
PIR, Thrombocytopenia in infants and children, 2011
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