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A LJ8-year-old woman is seen for evaluation of thrombocytopenia. She has no history of abnormal bleeding. She has a history of IV drug abuse. On physical exam. there is no lymphadenopathy or palpable splenomegaly. Complete blood count (CBC) shows leu kocyte count of 6.700/pL. hemoglobin 1 3 .7 g/dl. and platelet count LJ6,000/pl. The peripheral blood smear is shown below.
The liver-spleen scan does not show hypersplenism. Laboratory results reveal chronic hepatitis C infection. What is the most likely mechanism of thrombocytopenia in this case?
- Decreased thrombopoietin production
- Direct marrow suppression from the viral infection
- Immune-mediated platelet destruction
- Platelet sequestration despite normal spleen size
Medicine
C. In this patient, who has normal liver function and no other cytopenias, immune-mediated platelet destruction secondary to hepatitis C infection is the most likely etiology. Platelet autoantibodies have been detected in 66% of HCV-infected individuals. Choices A and B represent causes of thrombocytopenia, which would be prominent in advanced cases of hepatitis C infection (Br J Haematol. 2005;129:8 1 8-824).
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