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Suggest Treatment For Rashes & Mouth Ulcer With Low Platelet Count
my mother got some skin rashes and mouth ulcers(with bleeding in gums) a few days ago and when checked, it was found that her platelet count was less than 75000. the doctor advised us to shift her immediately to some hospital which we did. it was found that her platelet count has dropped to lower than 10000 and has maintained there for last 6 days now.earlier they said that she has ITP and they started wysolong steroid orally. after few days they said that here ANA is positive (ratio 1:40 for primary dilution and ratio 1:80 of end point titre) and thus she has SLE. i am still confused about the treatment path that they are following. shs is 52 and weighs 78kg. can somebody help and guide what to do
Fri, 24 Feb 2023
Hi,
From the history and data provided by you, it seems that she had some infection, as a result of which, she got skin rashes and mouth ulcers, most probably, some viral infection. Bleeding gums may be due to decreased platelet count.
To me, it does not appear a case of ITP, as usually in ITP, such drastic fall of platelets (75000 to 10000 in one day) is not seen. Similarly, it does not appear to be related to SLE also, as in SLE, though, pancytopenia is very commonly seen due to involvement of liver, spleen and bone marrow, but isolated thrombocytopenia is rarely seen. Just positivity of ANA also does not explain thrombocytopenia.
Again to emphasize, I think it to be as a result of some viral infection due to which, there was a steep fall in platelet count. Most of the times, fall in the platelet count is self limiting in viral infections and here also, it is static at a count of 10000 for the last 6 days. Hence, in my opinion, the patient should be just observed with only symptomatic treatment, avoiding any unnecessary medication, as certain medicines may themselves cause, thrombocytopenia.
However, if the count of platelets falls below 10000, then there may be requirement of platelet transfusion to prevent the fatal bleeding episodes. Also, if necessary, then platelet transfusion is to be done under close observation, taking into account of benefits vs risks, as platelet transfusion, itself may cause, thrombotic formation in the arteries with fatal consequences, many a times.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Satnarain Bansal, General & Family Physician
From the history and data provided by you, it seems that she had some infection, as a result of which, she got skin rashes and mouth ulcers, most probably, some viral infection. Bleeding gums may be due to decreased platelet count.
To me, it does not appear a case of ITP, as usually in ITP, such drastic fall of platelets (75000 to 10000 in one day) is not seen. Similarly, it does not appear to be related to SLE also, as in SLE, though, pancytopenia is very commonly seen due to involvement of liver, spleen and bone marrow, but isolated thrombocytopenia is rarely seen. Just positivity of ANA also does not explain thrombocytopenia.
Again to emphasize, I think it to be as a result of some viral infection due to which, there was a steep fall in platelet count. Most of the times, fall in the platelet count is self limiting in viral infections and here also, it is static at a count of 10000 for the last 6 days. Hence, in my opinion, the patient should be just observed with only symptomatic treatment, avoiding any unnecessary medication, as certain medicines may themselves cause, thrombocytopenia.
However, if the count of platelets falls below 10000, then there may be requirement of platelet transfusion to prevent the fatal bleeding episodes. Also, if necessary, then platelet transfusion is to be done under close observation, taking into account of benefits vs risks, as platelet transfusion, itself may cause, thrombotic formation in the arteries with fatal consequences, many a times.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Satnarain Bansal, General & Family Physician
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