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