- 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