Relapsing Chronic Immune Thrombocytopenia and Thrombosis: A Case Report

Immune thrombocytopenia (ITP) involves an acquired, immune-mediated disorder involving autoantibodies, which target platelet antigens. It may be primary or secondary to an underlying condition. While some may be asymptomatic, others may experience easy bruising, petechiae, purpura, epistaxis, bleeding from the gums, menorrhagia, hematuria, melena, or hematochezia. This is a case of a 21-year-old female who presented to the Emergency Room after experiencing several days of intermittent bruising and menorrhagia. She was found to have a platelet count of 16,000/μL and hemoglobin of 9.7 g/dL with a normal white blood cell count. One of the many clinical challenges for ITP corresponds to the lack of sensitive or specific diagnostic tests. Treatment is strongly advised for those with active bleeding, severe thrombocytopenia or if an invasive procedure is needed. Options for treatment are initially limited to corticosteroids. Alternative treatment options include intravenous immunoglobulin, rituximab, and thrombopoietic receptor agonists. This case was complicated by a recurrence of thrombocytopenia with bleeding despite corticosteroid treatment, followed by thrombosis in the setting of possible antiphospholipid syndrome. The goals for treatment involved not only increasing the platelet count to a level that decreases the risk of bleeding complications but also improving the patient's quality of life. Furthermore, clinical challenges were involved when considering the management of thrombosis in a patient with chronic ITP.