Idiopathic thrombocytopenic purpura

Answer 1: I would suggest 2 possible diagnosis
(A) ITP as استاذ هيماتولوجست said & suggested
(B) Gestational thrombocytopaenia

Answer 2: Since there is no previous plt count data it is difficult to distinguish between both diagnosis by performing anti=platelets antibodies can not be much helpful. However, if this patient have had low plt count during early pregnancy i would say it is ITP case because Gestational thrombocytopaenia can appear late in Pregnancy. In addition, ITP in mother can give low plt count to the baby after delivery whereas Gestaional will not. Preeclambsia can not be excluded as well as a cause. However to diagnose this , high blood pressure with proteinuria has to be ruled out. in this case preeclambsia is excluded as proteinuria
is at normal level.
Answer (3): I am suprised why all such investigations requested to come with this possible diagnosis, however to come up with answer i would say:
Since patient showed no symptoms of bleeding it wasnt important to do PT & APTT, however the only abnormal result seen as thrombocytopaenia. this suggests quantitative platelets abnormality that possibly due to anti-platelets antibodies that destruct circulating platelets. Viral infection could be also a possible cause which was excluded by viral titre test and other investigations. Preeclambsia was also excluded as a cause due to normal protein level in urine <0.2

Please what about the function of the megakaryocytes ? Abnormal megakaryocytes with basophilic cytoplasm & without platelet budding or with pink cytoplasm & partial platelet separation .If the previous findings are present , it will encourage the diagnosis of ITP . ....................Thanks a lot .

Almost always isolated thrombocytopenia with mild anemia & without abnormal cells ( Blasts ) in the peripheral hemogram is considered ITP until proved otherwise .

يا جماعة قبل ما نشك في اي حاجة
let us rule out any errorneous plt count
then let us thing about diagnosis
so I suggest to perform pletelet count on a second sample

Dear Ashraf thanks for ur feedback but we are analysing only a case presentation, however it should be well known any abnormal laboratory test has to be repeated

If the platelet count is correct, and as he said in the case that megakaryocytes are normal in number in the BM, but he did not mention their morphology, also if the case is preeclampsia the coagulation tests will be prolonged but this is not the case, this raises the suggestion of ITP.
But also transient thrombocytopenia is also a suggestion.
thank you all

Brother Ashraf thanx for ur valid information which i missed and i admire i have learnt some thing new today. Thanks once more

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