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What can cause low platelets and anaemia in children?

Q: My friend's 6-year-old son suddenly burst into itchy rashes during a picnic. We took him to a doctor who conducted blood tests, which revealed blood platelets at 5000 & haemoglobin was 7. After hospitalisation & subsequent treatment, he has been advised blood transfusion every 48 hours until his counts stabilises. However, he seems to show no side effects and as usual is happy go lucky. What seems to be wrong and what are the implications and sensible treatment? As per my layman's knowledge the assessment indicates cancerous bindings. Please advise.

A:The child has anaemia (low haemoglobin) and severe thrombocytopaenia (low platelet count). Platelets (thrombocytes) are a type of blood cells, which are derived in the bone marrow from large cells called megakaryocytes. They are critical for the clotting of blood and have a life-span of about 10 days. The normal platelet count ranges from 150,000 - 400,000/ml and a reduction in platelets is referred to as thrombocytopaenia. This may be mild (100,000 - 150,000/ml), moderate (50,000 - 100,000/mlƒw) or severe (less than 50,000/ml). Platelets may be low due to: a) increased destruction (immunological, infections, drugs; gestational thrombocytopaenia) or utilisation (disseminated intra-vascular coagulation; abnormal vasculature as seen in haemolytic uraemic syndrome & thrombotic thrombocytopaenic purpura), b) decreased production (leukaemia, aplastic anaemia, megaloblastic anaemia, drugs, infections or c) sequestration in the spleen (cirrhosis of liver). Even though there is a diverse list of potential underlying causes of thrombocytopaenia, most cases fall within two major categories: impaired platelet production or accelerated platelet destruction. Idiopathic thrombocytopaenic purpura (ITP) is the presence of isolated thrombocytopenia with a normal bone marrow and the absence of other causes to account for it. ITP is caused by increased peripheral platelet destruction, with most patients having antibodies to specific platelet membrane glycoproteins while relative marrow failure may contribute to this. No treatment is required when the platelet counts are more than 50,000/ml. Treatment is indicated a) when platelets are less than this and there is significant mucous membrane bleeding; b) in patients with hypertension, peptic ulcer disease or vigorous lifestyle who have a risk factor for bleeding and c) when platelet count <20,000-30,000/ml. Glucocorticoids and intra-venous gammaglobulins (I.V. Ig) are the mainstays of medical therapy. Their use and dose is dictated by the symptoms, patient's clinical condition and the platelet count. Platelet transfusion is indicated for controlling severe haemorrhage. Platelet survival is increased if the platelets are transfused immediately after I.V. Ig infusion. Please get the child examined and get a complete blood count with a peripheral smear examination done. If warranted, a bone marrow examination may also be required.

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