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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What cause drop in platelet count?

My partner (aged 67) has diabetes (injection controlled). He is now being investigated for ITP as his platelet count fell dangerously low (to 1). After 4 days in hospital and steroid treatment it is back to 8. He has had a bone marrow test (result awaited). He is concerned that injecting himself for diabetes causes a lot of bleeding (of course) and is worried he has early leukaemia. His blood count is, however, normal in all respects except for the sudden platelet drop last week. Can you give any opinion on this?
Thu, 27 Nov 2014
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Internal Medicine Specialist 's  Response
Hi,

Thank you for your query. I can understand your concerns.
Immune thrombocytopenic purpura (ITP) is an acquired disorder in which there is immune-mediated destruction of platelets and possibly inhibition of platelet release from the megakaryocyte.
ITP may be associated with other autoimmune disorders, particularly systemic lupus erythematosus (SLE) but not with diabetes of which Type 1 diabetes is immune-mediated.
Initial treatment in patients without significant bleeding symptoms, severe thrombocytopenia can be instituted using single agents,traditionally steroid i.e.prednisone at 1 mg/kg to which your spouse responded (platelet count rose from 10000/c mm to 80,000/c mm).
(
Bone marrow examination is reserved for older adults (usually >60 years;your spouse is 67 years) or those who have other signs or laboratory abnormalities not explained by ITP, or in patients who do not respond to initial therapy.

Refractory thrombocytopenia (RT) may be due to Myelodysplastic Syndromes or the MDSs which can transform into refractory anemia with excess blasts in transformation (RAEB-t) / acute myeloid leukemia. However his blood count is, normal (which is otherwise against possibility of MDSs) in all respects except for the sudden platelet drop last week.
Wait for the detail bone-marrow examination report. If inconclusive go for bone-marrow biopsy.






Regards

Dr. T.K. Biswas M.D.
Mumbai
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Infectious Diseases Specialist Dr. Praveen G's  Response
Hello,
Welcome to HCM
Thanks for posting your query in HCM.
Normally, you have anywhere from 150,000 to 450,000 platelets per microliter of circulating blood.If platelet count falls below 1.5 lakhs, then it is called thrombocytopenia.

As his blood counts are normal,no need for your friend to become anxious.Uptil the results of bone marrow studies arrive,we cant come into conclusion about the cause for decreased platelets count.Some common causes being:

1.Idiopathic thrombocytopenic purpura (ITP)
2.Some infections like dengue fever
3.Autoimmune diseases like lupus and rheumatoid arthritis.

Hope you are happy with the answer.
Thank you
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