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Adopting baby. Thrombocytopenia, enlarged liver, mild anemia and distention in abdomen without clear diagnosis. What to do?

Answered by
Dr.
Dr. E Venkata Ramana

Pediatrician

Practicing since :2002

Answered : 3176 Questions

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Posted on Fri, 2 Aug 2013 in Child Health
Question: I am adopting a baby from China, and I have been matched with a baby that has the following symptoms with no clear diagnosis. Thrombocytopenia, enlarged liver(4cm), mild anemia, distention in abdomen. Any ideas? Hepatitis negative and leukemia ruled out with bonemarrow test. We have asked for additional info and test, but patiently waiting....
doctor
Answered by Dr. E Venkata Ramana 4 hours later
Hi,

Thank you for your query on Healthcare Magic.

Thrombocytopenia is a condition with low platelet count in peripheral blood.

The causes of thrombocytopenia are decreased production of platelets in bone marrow, breakdown and destruction of platelets, or entrapment of platelets in the spleen.

Decreased production of platelets in bone marrow occurs in conditions of bone marrow involvement such as aplastic anemia, leukemia, bone marrow failure which is seen in marrow infiltration.

This condition can be ruled out with bone marrow aspiration or biopsy test.

As the child bone marrow test was done, this is not a cause of low platelet count in this child.

The other possibilities are destruction platelets in peripheral blood by spleen,
auto antibodies, drugs, and entrapment.

Congenital TORCH infections also cause thrombocytopenia, anemia, liver enlargement, skin rash with bleeding spots, and abdominal distension.

For this a blood test for TORCH profile is useful to diagnose the condition.

Hemangioma (abnormal tuft of small blood vessels) in the body will trap platelets and cause destruction of them leading to thrombocytopenia.

Hyper function of spleen (hypersplenism) also leads to thrombocytopenia.

Drugs also lead to low platelet count. The other causes are like infections such as malaria, dengue fever.

So the following investigations and information is useful to know the cause and outcome of thrombocytopenia in this child :

1.Peripheral smear

2.Hemogram

3.Bone marrow study

4.TORCH profile

5.Drug and family history

6.Other investigations like ultrasound abdomen and pelvis to know the liver and
spleen condition.

Therefore the above information may be required to know the causes of the child medical problems.

I advise you to coordinate with your doctor and the authorities involved in the adoption process to get the information and to solve the problem in the child.

Hope I have answered your query, if you have any clarification please let me know.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. E Venkata Ramana 5 hours later
Yes I am working with my pediatrician. Thank u for ur quick response. Do I still need to ask for a torch beping that he is 18 mths old?
doctor
Answered by Dr. E Venkata Ramana 48 minutes later
Hi,

Thank you for getting back.

And I am so grateful to you for your kind appreciation.

TORCH infections may present with this type of clinical picture from birth to childhood, so TORCH Profile to be included in the evaluation of thrombocytopenia, anemia, and with liver enlargement.

You can discuss this issue with your pediatrician.

Hope I have answered your query, if you have any clarification please feel free to get back.

Best regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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