Thrombocytopenia (ITP)
Given History, Exam, and Workup presentation most consistent with ITP.
I have low suspicion for DIC, TTP, Sepsis (endocarditis, meningitis), Vasculitis.
ED Workup: CBC, BMP, PT/INR, Fibrinogen, LDH, D-dimer
Consult: Hematology
Disposition: Discharge home. Patient has no active significant bleeding, is well appearing with reassuring vital signs and is agrees with plan to follow up outpatient within 24-72 hours with primary care practitioner.
- Presentation
- ITP: Looks well but is oozing bleeding or bruised
- TTP and DIC look sick
- Management
- Steroids
- Query use with Hematology because it is delays diagnosis of new onset leukemia as it affects the bone marrow biopsy (B-symptoms? All cell lines down?)
- Steroids
Vasculitis
+ diffuse petechial rash and pain
Given History, Exam, and Workup presentation most consistent with Vasculitis.
I have low suspicion for ITP/TTP, Hepatitis C, Sepsis (endocarditis, meningitis).
ED Workup:
CBC, BMP, Blood Cultures (Doubt bacteremia but will send blood cultures with expected TFU to r/o bacteremia causing emboli)
Consult: Rheumatology [Query steroid therapy (prednisone 60mg) vs observation and further in-hospital workup]
Disposition: Admit for further workup
PEARLS
- No steroids if infection obviously
- HEP C more likely hands and feet
Ty Dot Phrase 