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A 2 3-year-old female patien t presen ts wi th com plai n ts of "spots on my legs ." She has been in her normal state of health recen tly with the exception of cold symptoms that las ted for 5 days and have now resolved . Complete blood count shows hemoglobin of 1 LJ.5g/dl. leukocyte count of 8.900/,LLL. and platelet count of 1 3 ,000/,LLL. Photographs of the patient and her peripheral blood smear are shown below.
What test(s) would be appropriate in the evaluation of this patient?
- Bone marrow biopsy and aspiration
- LDH, haptoglobin, unconjugated bilirubin
- HIV, hepatitis C, ANA
- Antiplatelet antibodies
- ADAMTS- 13 level
Medicine
C. Blood smear shows an absence of platelets with normal red blood cells. Primary immune thrombocytopenia (ITP) is diagnosed after exclusion of secondary conditions such as HIV infection, hepatitis C, and SLE. Antiplatelet antibodies are not helpful and are not indicated in the evaluation of ITP. ADAMTS-13 deficiency is associated with thrombotic thrombocytopenic purpura (TTP) but the hemoglobin is normal and there are no schistocytes in the blood smear. Bone marrow biopsy is appropriate in older patients to rule out myelodysplastic syndrome (MDS).
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