A patient presents with easy bruising and a platelet count of 50,000/µL. The peripheral smear shows large platelets. What condition does this suggest?
- A) Immune Thrombocytopenic Purpura (ITP) ✓
- B) Thrombotic Thrombocytopenic Purpura (TTP)
- C) Myelodysplastic Syndrome (MDS)
- D) Essential Thrombocythemia
The correct answer is:
A) Immune Thrombocytopenic Purpura (ITP)
Explanation:
- Easy bruising and thrombocytopenia (platelet count of 50,000/µL) suggest a disorder affecting platelet numbers.
- Peripheral smear showing large platelets is characteristic of ITP, where the bone marrow compensates for platelet destruction by releasing young, larger platelets.
- ITP is an autoimmune disorder where antibodies target platelets, leading to their destruction in the spleen.
Why Not the Other Options?
-
B) Thrombotic Thrombocytopenic Purpura (TTP):
- Typically presents with microangiopathic hemolytic anemia, thrombocytopenia, fever, neurological symptoms, and renal dysfunction.
- Peripheral smear would show schistocytes (fragmented RBCs), not just large platelets.
-
C) Myelodysplastic Syndrome (MDS):
- More common in elderly patients, often with pancytopenia or dysplastic blood cells.
- Smear may show hypogranular or abnormal platelets, but large platelets are not a hallmark.
-
D) Essential Thrombocythemia:
- Usually presents with thrombocytosis (high platelet count), not thrombocytopenia.
- Platelets can be large, but the count is much higher than 50,000/µL.
Conclusion:
The most likely diagnosis is ITP, given the isolated thrombocytopenia and the presence of large platelets.
