•A bone marrow biopsy is performed. The marrow cellularity is increased. Numerous megakaryocytes are present with focal clustering. There is no evidence of dysplasia in any cell lines. How does this help your differential?
•How would you approach the work-up of thrombocytopenia ????
No schistocytes so no TTP or DIC
Lupus: not ruled out, but this is a male. Possible in female
Do you treat--if he has nosebleeds and bruising but is otherwise asymptomatic.
Should get the platelets up with treatment. Don't wait to see if it spontaneously resolve. Children with ITP do it in response to children, but this isn't a child. Adults rarely resolve spontaneously. Primary treatment is steroids in ITP. Steroids are immunosuppressive--prevent antibody production. Use high dose steroids. Probably will stay in remission--resistant ITPs have other treatments. If don't work then is chronic ITP. Relapsing ITP also exists.
Flow: Thrombocytopenia detected by automated blood counter -> confirm by slide evaluation -> is there an obvious reason for thrombocytopenia (recent chemo, radiotherapy, splenomegaly, hemodilution) -> Yes (no futher testing) or no -> perform bone marrow exam. Megakaryocytes -> decreased (examine marrow for infiltrative disease, aplasia, etc) or normal/increase -> other marrow elements? -> normal (peripheral platelet destruction--exclude DIC, TTP, drugs, SLE-->ITP) or abnormal (evaluate for primary hematologic disease)