Hi doctor, My mom is 57 years old. She was diagnosed with TB disease two months back through exclusion as her tests were negative but she had enlarged lymph nodes in the chest, low fever, night sweats, etc. Biopsy showed negative for lymphoma and sarcoma. She started ATT medicine and after 10 days, she got rashes so the doctor stopped. After 10 days, she was restarted with ATT and suddenly she got purpura and bleeding from nose and cough. She was taken for tests, where her platelets came as 10000. It has been 12 days and she has been on steroids as sos, Rivolade (past 3 days) but the platelets are still below 10000 and RBC and Hb are also dropping. She is bleeding through urine and stool. Her other tests are normal including bone marrow biopsy. Attaching her latest report. Please advise.
Hello, Welcome to the icliniq.com. According to your history ITP (idiopathic thrombocytopenic purpura), might comes under suspicion. But you are not having ITP, as bone marrow is normal and megakaryocyte not showing any sign of ITP. Check hypersplenism by USG (ultrasound)abdomen investigation. Second, rule out dengue by Ig M dengue testing (ELISA or card test). Check your kidney profile investigation for serum urea, creatinine, etc. Blood infections has to be ruled out like septicemia by blood culture. Your bleeding and all other complaints are because of low platelets. Low platelets with bleeding need transfusion of platelet in form of SDP or random donor platelet. Hence first rule out all the above cause if present and then if no cause found we have to strongly suspect autoimmune hemolytic anemia because of your CBC report (attachment removed to protect patient identity), showing normoblast and high reticulocyte count. And for that further investigation done with DCT (direct Coombs test)and other suitable workup. Steroid needed if DCT is positive and autoimmune hemolytic anemia if confirmed.