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Question: Unsteady platelet count

sathish57 - Mon Feb 05, 2007 7:23 am	Share \|
Hello dr, My cousin is now 21 yrs old, female for whom the platelet count is not all constant. It was 1.15lakh in 2002 and keeps on varying low down to even 3000. Now it is again 77000 and doctors were not able to diagonise even after all the results including the bone marrow test. She has a scar in the right part of her nose and one more seems to come soon on the left part too. In 2002, she was very week and was given 8 units of platelets. Now what is wrong & what is deficient with her dr? What should we do to make her alright? She s physically good, but sometimes become tired. I have her complete report of all these years but if you want to take a look at it, how do I send it to you dr? Thank you in advance.
Dr. Safaa Mahmoud - Mon Feb 05, 2007 12:42 pm	Share \|
Hello, Causes of thrombocytopenia are classified into 3 main types according to where the problem is, these type are: -Sequestration problem: due to spelenomegally which causes platelet destruction and shorter life span. - Decreased production: due to BM problems like MDS, infiltration by leukemic cells in which other element of blood components may be affected, selective impairment in platelet production occur also due to bone marrow defects. -Increased destruction: Immune or non immune destruction. Idiopathic autoimmune platelet destruction ITP is the commonest cause of isolated thrombocytopenia in young females, the diagnosis is usually done by exclusion of other causes. Lab results in most of the cases show: -isolated thrombocytopenia -increased MPV -normal PT, PTT You can send provide us with the list of the investigations done and the results of the last one. What kind of treatment is being offered for her, and is there any other family history of similar condition? Keep us updated. Best regards
sathish57 - Tue Feb 06, 2007 12:45 am	Share \|
Thank you Dr. Safaa Mahmoud for your valuable time. I am updating you with the complete details of the patient. Kindly tell what exactly the problem is and how can it be over come? BIOCHEM REFERENCE RANGES: NAME:xxxxxxx AGE:16 SEX:F 11-04-2002: Bone marrow Unsatisfactory for evaluated suggest repeat Biopsy 6469/02 URG Bone marrow LDH 325 U/L CBC profile: BF-3, Poly-57, Eosin 1, Baso 1, Lymph 31, mono 7, Aniso+Burr cell prt MCV 36.6 f1 MCH 29.7PG MCHC 34.3 G/DL RDW 14.1% TOTAL WBC 5500/CC MM HB - 10.2 GM/DL PLATELET COUNT - 5000 ccmm Creatinine 0.8mg% Reticulocyte count 0.7% 13-04-2002 Lead blood-13 ug% 15-04-2002 Biopsy 6724/02URG Scanty norms to midly hypocellular marrow with adequate numbers megakaryocytes, trephine biopsy 0811 socrates mathew & sheila. BONE MARROW URGENT Impression: Cellular marrow with iron deficiency & adequate m consistent with peripheral platelet destruction 16-04-2002 BONE MARROW REPORT Cellularity of fragments: Normo cellular. Adequate mega karyocyte Smears : Normo cellular DC count on 200 cells Erythroid precursors - 22.5% Myeloblasts - 0% Promyelocytes & myelocytes - 16% Metamyelocytes & Bandforms - 36% Neutrophils - 18.5% Eosinophils & precursors - 2.0% Lymphocytes - 5.0% Plasma cells - 0% Erythriod maturation & morphology - Normoblastic erythroid maturation with mild delay in haemoglobinisation Myeloid maturation & morphology - All stages seen Lymphoid cells - Normal Plasma cells - Normal Megakaryocytes - Adequate in number. No platelet budding seen Other cells - No abnormal cells or parasites Special strains - Iron : Absent iron stores Impression - Cellular marrow with iron deficiency & adequate megakaryocyte. Consistent with peripheral platelet destruction 06-05-2002: MEAN CORPUSCULAR VOLUME 90.7 RBC WBC DIFFERENTIAL Neutrophils- 64% Lymphocytes- 33% Monocytes- 3% WBC total- 11100/cu mm Platelet count- 130000 cc mm Haemoglobin - 11.7gm% 04-07-2002 WBC DIFFERENTIAL BAND FORMS 16% Neutrophils- 44% Lymphocytes- 37% Monocytes- 2% Eosinophils- 1% WBC total- 5600/cu mm Platelet count- 2,25,000 cc mm Haemoglobin - 13.5gm% 03-10-2002 WBC DIFFERENTIAL TOTAL WBC 4200/ CC MM PLATELET COUNT 142000 CC MM HAEMOGLOBIN 12.6GM% 26-12-2002 CBC PROFILE DC:NE:35% EO:05% B.Pic MCV 88.7 f1 MCH 31.1 PG MCHC 35.1 G/DL RDW 11.9% TOTAL WBC 5200/CU MM HB 13.1 GM/DL PLATELET COUNT 56000 CC MM relapse of ITP 15-05-2003 CBC Profile DC:NE:49 EO:02 Ba:01 MO:06 LY:42 B.Pic+ovalocytes present. On smear platelet count is 30,000/ccmm MCV 89 f1 MCH 31.2 PG MCHC 35.0 G/DL RDW 12.9% TOTAL WBC 6400/CU MM HB 12.4 GM/DL PLATELET COUNT 25000 CC MM 06-06-2003 WBC DIFFERENTIAL BAND FORMS 04% Neutrophils- 36% Lymphocytes- 56% Monocytes- 4% 16-06-2003 WBC total 3700/cc mm Platelet count 345000 cc mm Reticulocyte count 1.2% Haemoglobin 10.7gm% 01-09-2003 WBC DIFFERENTIAL BAND FORMS 05% Neutrophils- 45% Lymphocytes- 51% Monocytes- 1% Eosinophils- 03% WBC total- 6600/cu mm Platelet count- 58000 cc mm Haemoglobin - 12.6gm% 29-12-2003 WBC DIFFERENTIAL BAND FORMS 05% Neutrophils- 49% Lymphocytes- 38% Monocytes- 3% Eosinophils- 05% WBC total- 4500/cu mm Platelet count- 9000 cc mm Reticulocyte count 1.5% Haemoglobin - 12.4gm% Age-18 05-02-2004 WBC DIFFERENTIAL Neutrophils- 54% Lymphocytes- 38% Monocytes- 2% Eosinophils- 07% Basophils- 01% WBC total- 4600/cu mm Platelet count- 1,44,000 cc mm Haemoglobin - 13gm% 07-02-2004 Ana AF786 Positive (speckled) suggest sample for DS DNA and U1RNP ELISA 27-04-2004 WBC DIFFERENTIAL toxic granules prt Neutrophils- 77% Basophils - 01% Lymphocytes- 18% Monocytes- 1% Eosinophils- 03% WBC total- 4800/cu mm Platelet count- 58000 cc mm Haemoglobin - 12.6gm% toxic granules prt Platelet count - 49000 cc mm Haemoglobin - 12.9 GM% 16-06-2004 URINALYSIS ROUTINE Mucus ++ Ca.oxalate cry yeast cells PRT Glucose - Negative Bilirubin - Negative Ketone - Negative Speci.gravity- 1.025 Blood - Negative PH - 6.0 Protein - trace Urobilinogen - 1.0 Nitrite - Negative Leukocytes - trace RBC - 2 - 4 WBC - 4-6 WBC DIFFERENTIAL BAND FORMS 01% Neutrophils- 58% Lymphocytes- 33% Monocytes- 3% Eosinophils- 05% WBC total- 4400/cu mm Platelet count- 74000 cc mm Haemoglobin - 12.8gm% LFT Bilirubin total - 0.9mg% direct - 0.3mg% Protein total - 6.9% Albumin - 4.5gm% SGOT - 22 U/L SGPT - 11 U/L ALK PHOS - 70 U/L Serum complement CL887 CH 70% C3C C4 DS DNA Estimation (ELISA) DS1269 Anti DS DNA antibody level within normal limits Age 19 17-02-2005 WBC DIFFERENTIAL Neutrophils- 65% Lymphocytes- 29% Monocytes- 3% Eosinophils- 03% WBC total- 4700/cu mm Platelet count- 40000 cc mm Haemoglobin - 12.4gm% plt on smear - 75000 glant plt prt 30-06-2005 CBC Profile DC:Bn:05 EO:06 NE:62 LY:25 B.Pic normo chromic normo cytic MCV 93.3 f1 MCH 31.9 PG MCHC 34.2 G/DL RDW 11.9% TOTAL WBC 4900/CU MM HB 12.7 GM/DL PLATELET COUNT 34000 CC MM RBC 3.97 HCT(PCV) 37.1 Age 21 28-01-2007 (will update with other details too) Platelet count - 77000 cc mm Doctors were nt able to diagonise anything from the report doctor. So please kindly help me. Once again Thank you a lot in advance doctor.

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