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Spot Diagnosis

Discussion in 'Spot Diagnosis' started by neo_star, Mar 14, 2013.

  1. neo_star

    neo_star Moderator

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  2. Emergency medicine Mike

    Emergency medicine Mike Bronze Member

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    Bruising. In diferential idiopathic thrombocytopenic purpura.
     

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  3. neo_star

    neo_star Moderator

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    i saw a comment on facebook which says - may be played too much soccer with older brothers. I think it's a fantastic differential, but i hav a younger brother and so i can tell u that if it indeed was the case, then the older brother wud hav visited the ER with ATC - 'acute testicular crisis ' :hhh:





    on a more serious note...what cud be the one test ( blood test ), that cud differentiate - the diagnosis by E M Mike from the diagnosis of bruising on the field of play ?...it can't be from Hx....since most children in this age group will b into some sport or other, which involves physical contact esp. soccer ( most common ).
    the last thing u wanna do is being callous and missing out on something gross :oops:
     

  4. Rosita

    Rosita Active member

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    if the upper respiratory infection was by some microorganism like mycoplasma,then may be these bruises are the results of thrombocytopenia .
     

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  5. Chriss

    Chriss Well-Known Member

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    Responding to neo_star question, a complete blood count should be done.
     

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  6. neo_star

    neo_star Moderator

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    Answer: Idiopathic Thrombocytopenic Purpura

    Discussion

    Chriss is right about doing a complete CBC. and it's imp. to look at the slide under a microscope ( and not just merely put the blood sample into a cell counter ).
    I recently asked for a CBC in a child who came with some bruising and looked exactly like the image in the challenge. He was having fever and upper respiratory congestion from a few days which when subsided was followed by a rash on his trunk and petechiae, mostly on his legs and arms. The CBC report showed a low platelet count (50 k ), schistiocytes and P vivax.

    At this stage, i had in mind : Evans syndrome ( i.e Autoimmune attack on platelets + Autoimmune attack on RBCs ), Malaria and Dengue ( becos of the rash, appearing during defervescence and the fever returning again ( common in my part of the world, although this is off season ). So i asked for a hematocrit and IgG and M to Dengue. The hematocrit was high ( inspite of malaria ), and the child was positive for Dengue....child was closely monitored for Fluid status and started on Malaria Rx and was discharged in 5 days ( his stay being uneventful ).

    So, yes a simple CBC and peripheral smear ( thick and thin slides ) is a treasure trove of information and is here to stay
    (-:
     

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