Part 2: Immune Thrombocytopenia

Thomas G. DeLoughery, MD, FACP

Professor of Medicine, Pathology, and Pediatrics, Division of Hematology/Medical Oncology, Knight Cancer Center, Departments of Medicine and Pediatrics, and Division of Laboratory Medicine, Department of Pathology, Oregon Health Sciences University, Portland, OR

Question 5

A 35-year-old man who had a renal transplant in 2006 is admitted with sepsis. He slowly improves over 1 week but then develops new-onset hematuria and is found to have a platelet count of 3 x 103/ÁL. Review of his quite extensive charts show occasional episodes of mild thrombocytopenia (lowest 68 x 103/ÁL a week after his transplant), but none to this degree. His exam shows petechiae but is otherwise unremarkable. His current medications on hospital day 8 include:

  • Ceftriaxone since hospital day 1
  • Vancomycin since hospital day 1
  • Ranitidine since hospital day 7
  • Trimethoprim/sulfamethoxazole (TMP-SMX) since 2006
  • Cyclosporine since 2006

His smear is unremarkable, his renal function continues to improve, and his lactate dehydrogenase (LDH) level is normal. What is the best approach to managing this patient's thrombocytopenia?

  •  High-dose dexamethasone and IVIG
  •  Stopping TMP-SMX
  •  Stopping vancomycin
  •  Stopping cyclosporine
  •  Stopping all his medications

Updated 6/01/2011 • jdw | Copyright ©2014 Turner White Communications