Differential Diagnosis for a 25-year-old Female with Severe Nosebleed, Spontaneous Bruises, and Low Platelet Count
- Single most likely diagnosis:
- D. chronic idiopathic thrombocytopenia purpura (cITP): This condition is characterized by a low platelet count (thrombocytopenia) with an otherwise normal complete blood count (CBC), which matches the patient's laboratory results. The gradual worsening of symptoms over months also aligns with the chronic nature of cITP.
- Other Likely diagnoses:
- A. acute idiopathic thrombocytopenia purpura (aITP): Although the acute form typically presents more suddenly, some cases can have a subacute onset, making this a consideration. However, the progressive worsening over months leans more towards a chronic condition.
- B. Glanzmann’s thrombasthenia: This is a rare bleeding disorder characterized by a normal platelet count but dysfunctional platelets. However, given the patient's low platelet count, this diagnosis is less likely but could be considered if platelet function tests were abnormal.
- Do Not Miss diagnoses:
- C. acute lymphocytic leukemia (ALL): Although less likely given the normal other hematology parameters, leukemia can present with thrombocytopenia due to bone marrow infiltration. Missing this diagnosis could be catastrophic, so it's crucial to rule out leukemia with further testing, such as a bone marrow biopsy.
- Other conditions that could lead to thrombocytopenia and should not be missed include drug-induced thrombocytopenia, HIV, and systemic lupus erythematosus (SLE), though these would typically have other associated findings or symptoms.
- Rare diagnoses:
- Thrombotic thrombocytopenic purpura (TTP): Characterized by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, and neurological symptoms. The absence of other key features makes this less likely.
- Immune thrombocytopenia purpura (ITP) secondary to other autoimmune diseases: While ITP can be secondary to conditions like SLE or chronic lymphocytic leukemia, the absence of other symptoms or findings makes these less likely but still worth considering in the differential diagnosis.