Q: My 7 years old daughter continues to have low blood platelets. Her bone marrow checked out fine. She has been given haemoglobin injections to boost her counts but to have them only drop under 10,000 again. She is healthy, perhaps a little hyper active. It was only by noticing her bruising that we discovered her blood problem. What is the cause for this? We live in a very heavy gasoline chemical producing area where three neighbours have cancer and our dog died of cancer.

A:Immune thrombocytopenic purpura (ITP) is a condition in which a decreased number of circulating platelets (thrombocytopenia) produces a tendency to bleed, easy bruising (purpura), or leaking of blood from capillaries into skin and mucous membranes (petechiae). The platelets are coated with autoantibodies to some platelet proteins and this results in their sequestration within the spleen and ultimate breakdown. There is thus a shortened life span of platelets. If the bone marrow is unable to completely compensate by increasing the platelet production, there is a resulting thrombocytopenia. It is a diagnosis of exclusion after conditions like leukemia, bone marrow infiltration, myelodysplasia, aplastic anemia, or adverse drug reactions etc have been ruled out. In young children, ITP may be a manifestation of a primary immune deficiency syndrome or occur within a few weeks of recovery from a viral illness (EBV, CMV, hepatitis, rubella, varicella etc.). Treatment aims to increase the platelet count to a safe level while awaiting spontaneous or treatment-induced remission. After 6 months, if the platelet count cannot be maintained at a safe level or it cannot be maintained at a safe level with medication without serious treatment-related toxicity, surgical removal of spleen is often performed. More than 80% of children with untreated ITP have a spontaneous recovery with completely normal platelet counts in 2-8 weeks. There are several known toxins in gasoline (like benzene & lead) some of which are confirmed human carcinogens. Gasoline is known to be a neuronal, reproductive and developmental toxin. You would need to consult a pediatric hematologist and perhaps consider moving out of the area.