English

Abstract

A 45-year-old multiparous female was admitted 1 week back in Bapuji hospital attached to J J M medical college in view of iron deficiency anaemia and had underwent 3 pints of blood transfusion and was discharged with haematinics. Now after 5 days patient noted purpura and ecchymosis over her all four limbs which has increased from past 2 days. Patient also noticed epistaxis, subconjunctival haemorrhage in the last 1 day which brought her to Bapuji hospital in November 2019. Patient had no history of fever, bleeding per rectum, melena, joint pains, headache, blurring of vision, loss of consciousness, seizures. No past history of bleeding manifestations, blood transfusions and medications altering haemostasis in the family. Complete hemogram showed Hb : 11.1 g/dl, total count: 7210 cells/cumm, platelet count: 22000 cells/cumm. Peripheral smear showed normocytic normochromic anaemia with severe thrombocytopenia. LFT showed serum bilirubin: 2.5 mg/dl, indirect bilirubin: 1.9 mg/dl with normal liver enzymes. Coagulation profile and fever profile was done to rule out other causes of thrombocytopenia and was found to be normal. Serum LDH levels were 856 u/l. Direct and indirect coombs test is negative. ANA was negative. USG abdomen shows no splenomegaly. Patient was transfused with 4 pints of platelets and repeat platelet count after 12 hours shows 19000 cells/cumm. This clinical picture with bleeding manifestation with history of blood transfusion suggested post transfusion purpura, patient was transfused with aphaeretic blood and iv immunoglobulins at 500 mg/kg/day for 5 days and corticosteroid prednisolone was given at the dose of 1 mg/kg body weight. Patient platelet count improved significantly to 72,000 cells/cumm on 3rd day of admission. Patient did not have further bleeding manifestation. Patient’s platelet count improved to 1.60 lakhs/cumm at the time of discharge. Patient couldn’t get anti platelet antibodies and HPA genotyping due to financial constraints.