Q: My son (6 months old) is very active but was tested for platelet counts which were found to be 30000 only. The doctors here gave 5 daily doses of a medicine (may be a steroid, was for Rs.500 for 500 mg) with which his platelet counts rose to 1.8. After 10 days it again came down to 45000. the doctor suggested no medicine and directed to avoid infection. We are very worried, kindly help.

A: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 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 thrombocytopenia. 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 (immunologic ¡V infections, drugs; gestational thrombocytopenia) or utilization (disseminated intra-vascular coagulation; abnormal vasculature as seen in haemolytic uremic syndrome & thrombotic thrombocytopenic purpura), b) decreased production (leukaemia, aplastic anaemia, megaloblastic anaemia, drugs, infections or c) sequestration in the spleen (cirrhosis of liver). Idiopathic thrombocytopenic purpura (ITP) is the presence of isolated thrombocytopenia with a normal bone marrow and the absence of other causes to account for it. Acute ITP is often preceded by an acute infection and has a spontaneous resolution within 2 months. No treatment is required when the platelet counts are more than 50,000/ml. Treatment is indicated when platelets are less than this and there is significant mucous membrane bleeding or 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, patients clinical condition and the platelet count. Platelet transfusion is indicated for controlling severe bleeding. Platelet survival is increased if the platelets are transfused immediately after I.V. Ig infusion. The prognosis is good with about 83% children having a spontaneous remission and nearly 90% children eventually recovering. More than 50% of them recover within 4-8 weeks.