10. A/P

A/P:

  • Thrombocytopenia - Recurrent ITP appears most likely, no evidence for TTP (no schistocytes or hemolysis), no drugs likely to suppress megakaryocytes, no clear signs of collagen vascular disease or neoplasia.

  • The PMH of ITP makes recurrence probably #1 but the history of recurrent infection and decreased immunoglobulins is worrisome for immunodeficiency.

  • Rx: IVIG, 400mg/Kg x 5d, Solu-Medrol, 80 mg

  • Thrombocytopenic risk for major bleeding, reverse Coumadin with Vitamin K

  • Further lab testing:
    • Ig quantification
    • DIC evaluation
    • antiplatelet antibodies
    • reticulated platelet count
    • CRYO, SPEP, UPEP
    • accessory spleen
    • bone marrow examination