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What Causes Chronic Idiopathic Thrombocytopenic Purpura?

Posted on Wed, 23 Apr 2014

Question: I have Chronic ITP take Nplate when needed had two 2.5 mg injections one 0n 3/ 13 and one on 3/20 my WBC on my last CBC was 15.4 I have no infection that I know of no ,fever . usually it is with in normal range. My Dr says it is probably caused by the Nplate reaction. this happens occasionally. is this a possible cause for the rise in count all other white blood work OK except 8.2 neutrophil count automatated

Answered by Dr. Ivo Ditah (4 hours later)

Brief Answer: Yes, a possible cause but rare, monitor! Detailed Answer: Hi and thank you so much for this query. I am so sorry to hear about this ITP and the recent increase in your WBC count. Though this could be possibly caused by Nplate injections, it is not commonly observed. I will not also want to act on a single number at this time. Monitor this WBC count in say 4weeks and let's see what the trend is. If it has returned to normal, then it was possibly caused by this injection and should it stay abnormally high, we may want to probe into possible causes of raised WBC. Infection is just one of the several causes and fever may not always accompany the early stages of an infection. In all, for now I think it may be associated with the injection of Nplate but monitoring would confirm or open the door for more investigations. I hope this helps. I wish you well. Thank you so much for using our services and do feel free to ask for more information if need be. Thanks. Dr. Ivo, MD.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ivo Ditah (4 hours later)

Last week: WBC COUNT 3.5 - 12.5 K/uL 8.1 Red blood cells count 4.10 - 5.70 M/uL 4.63 Hgb 13.0 - 17.0 g/dL 13.6 Hematocrit 39.0 - 51.0 % 40.6 MCV 80 - 100 fL 88 RDW, RBC 12.0 - 16.5 % 13.5 Platelets count 140 - 400 K/uL 44 Differential panel MAN DIFF Neutrophils %. Manual count 50 - 70 % 38 Lymphocytes % manual count 20 - 50 % 40 Monos %, man cnt 1 - 11 % 11 Eosinophils % manual count 1 - 5 % 3 Lymphocytes, atypical % 7 Metamyelocytes % 0 - 1 % 1 RBC's, morphology NORMAL Platelets,bld,ql, man ct DECREASE Platelets, morphology GIANT This week: WBC COUNT 3.5 - 12.5 K/uL 15.1 Red blood cells count 4.10 - 5.70 M/uL 4.80 Hgb 13.0 - 17.0 g/dL 14.5 Hematocrit 39.0 - 51.0 % 43.0 MCV 80 - 100 fL 90 RDW, RBC 12.0 - 16.5 % 13.4 Differential panel PLT/REVW Platelets count 140 - 400 K/uL 175 Neutrophils %, automated count 41 - 79 % 54 Lymphocytes %, automated count 13 - 44 % 39 Monos %, auto 5 - 14 % 5 Eosinophils %, automated count 0 - 6 % 2 Basophils %, automated count 0 - 2 % 1 Neutrophils auto count 2.1 - 7.4 K/uL 8.2

Answered by Dr. Ivo Ditah (7 hours later)

Brief Answer: I have reviewed these results! Detailed Answer: Hi and thank you so much for this follow up precision. I have reviewed the results fully. But for the WBC, there is no other alarming change except for the increased platelets count that was expected. I am for controlling these results at a later date and for sure this would turn out to be a lot better than now. The time lapse between the last normal count and this recent one with abnormal WBC is too sort t suggest that there is something troubling that we are missing here. It would not just be feasible. In all, control these results in 2weeks and let's go from there if it should remain abnormally high. I wish you well and feel free to update me when you get the new results. Thanks. Dr. Ivo, MD.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ivo Ditah (4 hours later)

2/8/14 2/14/14 2/20/14 3/4/14 3/7/14 3/10/14 3/13/14 3/16/14 3/20/14 3/27/2014 WBC 12.9 10.5 12.8 12.1 8.8 9.5 10.4 10.8 8.1 15.1 WBC history over the past few weeks above

Answered by Dr. Ivo Ditah (6 hours later)

Brief Answer: Like to see more values Detailed Answer: Hi and thank you so much for this well presented WBC trends. That of 3/16/14 is just out of phase with all other values. I will not act on this value unless it remains high or you report any other symptoms suggestive of a possible infectious process. I will not want to leave from tests to looking for an infection because this pays more attention to the laboratory and not the patient. Why don't we get more values after this first concerning values before becoming more aggressive if need be? Thanks and would like to see more values after this abnormal value before getting worried or more reassured that this is just nothing to worry about. Thanks. Dr. Ivo, MD.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ivo Ditah (1 hour later)

Before I was given Nplate for my ITP I had 4 rounds of intervenes Rubtuxan. After the forth round I blacked out and was hospitalized. They gave me head and complete body scans and every test they could think of. I had a WBC of 32000 they gave me antibotics which brought it down to normal. They said that they could find no signs of any kind of infections. I had no pain or weakness or fever. So they concluded I had what the DR called Leukemoid Reaction and discharged me. I take a CBC again April 1! will see what it reveals. Thanks for your great help and effort in answering my question.

Answered by Dr. Ivo Ditah (3 hours later)

Brief Answer: Let's see what the next numbers are! Detailed Answer: Hi and thanks for this follow up. There should be no rush in treating a laboratory finding. This is for several reasons. We treat a patient and not a result. Results simply offer more arguments in favor of one decision over another. I do not treat laboratory results. If your doctor were certain that this was a leukemoid reaction, he should not have given any antibiotics. Antibiotics treat infections and not leukemoid reaction. These two points contradict each other so greatly. It is good to exercise patience. If it is a leukemoid reaction, then it would clear off all by itself. If it is an infection, more symptoms and signs would help us to identify the exact nature of this infection,what antibiotics would be best indicated and the duration. Why would your doctor have choosen one drug over the other with no idea of what the possible infection is and what antibiotics are best indicated in such a condition? Let me get the follow up numbers and see where we head to from there. I wish you well and look forward to discussing more about this with you. Thanks. Dr. Ivo, MD.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ivo Ditah (2 days later)

results of CBC today. WBC down to 14,000 from 15.1 Red blood cells count 4.10 - 5.70 M/uL 5.08 Hgb 13.0 - 17.0 g/dL 14.8 Hematocrit 39.0 - 51.0 % 44.7 MCV 80 - 100 fL 88 RDW, RBC 12.0 - 16.5 % 14.1 Differential panel MAN DIFF WBC COUNT 3.5 - 12.5 K/uL 14.0 Platelets count 140 - 400 K/uL 203 General Information Collected: 04/01/2014 10:56 AM Resulted: 04/01/2014 3:07 PM

Answered by Dr. Ivo Ditah (31 hours later)

Brief Answer: Thanks for this update! Detailed Answer: Hi and thank you so much for this update. I know it is not exactly back to normal but a positive trend. I will not be aggressive towards this as I mentioned and would want to sit and monitor in future unless something alarming should come up now. I encourage you to sit and be relaxed knowing that we are not taking any extraordinary risk but simply staying true to the art of medicine and logical approach to illness without compromising the quality of care or possible outcomes. I wish you well. Feel free to ask for more information or clarification if need be. Thanks. Dr. Ivo, MD.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ivo Ditah (58 minutes later)

Thank You DR. for your continuing reply's. I take another CBC 4/6 /14 as per my DR 's request. She is not concerned about my rise in WBC she said this trend has happen prior . She says it is unusual for the wbc to rise from the Nplate ,but it does happen. Platelets usually follow a pattern. 177 on 3/27/14 205 4/1/14 at this point it usually takes a big drop. Then another Nplate injection and it will sometimes drop lower or rise up and stay up for another couple weeks. I am on a roller coaster with this ITP. I will just try to stay relaxed and trust in the good advise you have given me. I will send you my next results.

Answered by Dr. Ivo Ditah (3 hours later)

Brief Answer: Happy your doctor thinks so Detailed Answer: Hi and thanks for this follow up precision. I am happy reading and learning you are more relaxed. We would follow up with you and put an eye on what the numbers say so that we should be able to catch any significant abnormality that should be concerning. I wish you well and look forward to communicating and exchanging with you even more on this. Dr. Ivo, MD.

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Above answer was peer-reviewed by : Dr. Shanthi.E