Tuesday, December 29, 2009

Idiopathic thrombocytopenic purpura

From eMedicine:
Immune thrombocytopenic purpura (ITP) is a clinical syndrome in which a decreased number of circulating platelets (thrombocytopenia) manifests as a bleeding tendency, easy bruising (purpura), or extravasation of blood from capillaries into skin and mucous membranes (petechiae).
In persons with immune thrombocytopenic purpura (ITP), platelets are coated with autoantibodies to platelet membrane antigens, resulting in splenic sequestration and phagocytosis by mononuclear macrophages. The resulting shortened life span of platelets in the circulation, together with incomplete compensation by increased platelet production by bone marrow megakaryocytes, results in a decreased platelet count.
It started around the end of November, when we noticed Amelia had some patches of tiny red dots on her skin, and seemed to have a lot of bruises on her shins, and on her butt where her brother had whacked her a day or two earlier. So we took her to the doctor, who immediately said to bring her to the hospital. Fortunately we were sufficiently unknowledgeable to not be thinking about leukemia. After a few hours the doctors had decided it was ITP. It's not known what causes it (which is why it's idiopathic) - it seems to be triggered by some sort of viral infection. Normally you should have at least 150,000 platelets per cubic millimeter of blood, and 20,000 is a worrying level. Amelia had less than 10,000. But most cases in children are acute, and they recover over a period of months without needing treatment. The only advice is to make sure the child isn't playing rough or doing anything that comes with a risk of bleeding. A nosebleed that doesn't stop is a bad sign. We kept her out of school for a few days; 10 days after diagnosis her platelet count was 20,000; still much too low, but not as bad as it had been. Aside from keeping a watchful eye on her, life returned to normal.
7:30, Christmas morning. Ethan wakes us to say Amelia has a nosebleed and it's not stopping.
At least the traffic in to the hospital was light. She spent the day and night in hospital, for 10 hours hooked up to an IV line, delivering immunoglobulin to encourage her immune system to lay the hell off the platelets. She was a star, though: never complained, never cried - of course, she felt fine, aside from the nosebleed. And not only did she meet Santa (and the Lord Mayor of Dublin) when she was waiting to be seen by a doctor, but Santa came again during the night! "I love the hospital", she told me. The next afternoon, she was discharged and told to come back Tuesday for another blood test. Tuesday: by coincidence, her birthday. We had our Christmas dinner two days late, and the trip to see Granny and Granddad and all the cousins was cancelled. With due deference to the billions of people worldwide who are worse off than us, it was officially The Worst Christmas Ever.
Today's Tuesday, and my sweetie-pie is 4. And her platelet count is 43,000. Thank you, doctors, nurses, and medical science.

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