What are the history and physical (H&P) and assessment and plan (A&P) for a 2-year-old female with suspected Immune Thrombocytopenic Purpura (ITP)?

From the Guidelines

For a 2-year-old female with suspected immune thrombocytopenia (ITP), a comprehensive history and physical examination (H&P) is crucial to assess the severity of bleeding manifestations and rule out other causes of thrombocytopenia, as outlined in the American Society of Hematology 2019 guidelines for immune thrombocytopenia 1. The H&P should focus on:

• Onset and duration of symptoms, particularly petechiae, purpura, mucosal bleeding, or bruising that appeared suddenly
• Recent viral illnesses, medications, family history of bleeding disorders
• Systemic symptoms like fever, weight loss, or bone pain that might suggest alternative diagnoses
• Physical examination should carefully document the extent and distribution of petechiae and purpura, assess for lymphadenopathy, hepatosplenomegaly, and signs of active bleeding

Anatomy and Physiology (A&P) considerations include:

• Understanding the pathophysiology of ITP, an acquired autoimmune disorder characterized by a low platelet count resulting from platelet destruction and impaired platelet production 1
• Recognizing the clinical course of ITP, which may be different depending on whether it is primary ITP, occurs in the setting of additional autoimmune cytopenias, is the manifestation of a primary immunodeficiency, or is associated with an underlying autoimmune condition or infection (secondary ITP) 1
• Being aware of the potential complications of ITP, including bleeding events, which can be unpredictable and may not exhibit beyond bruising and petechiae, but can also include more serious mucosal bleeding, such as menorrhagia, epistaxis, gastrointestinal hemorrhage, hematuria, or, rarely, intra-cranial hemorrhage (ICH) 1

Assessment and plan should include:

• Obtaining a complete blood count with peripheral smear to confirm isolated thrombocytopenia (typically <20,000/μL in ITP) with normal red and white blood cell morphology
• Considering additional testing to exclude other causes, including bone marrow examination if atypical features are present
• Management depending on platelet count and bleeding severity, with options including observation alone for mild cases, or first-line treatment with a short course of oral prednisone or a single dose of IVIG for more severe cases 1

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

History and Physical (H&P) for Suspected ITP in 2 yo F

• The provided studies do not offer direct evidence for generating a History and Physical (H&P) for a suspected case of Immune Thrombocytopenic Purpura (ITP) in a 2-year-old female.
• However, a typical H&P for suspected ITP would include:
  • Medical history: inquiries about recent infections, medications, or vaccinations.
  • Family history: questions about bleeding disorders or autoimmune diseases.
  • Physical examination: looking for signs of bleeding, such as petechiae, purpura, or bruising.

Anatomy and Physiology (A&P) for Suspected ITP in 2 yo F

• The studies provided 2, 3, 4, 5 do not directly relate to the anatomy and physiology of ITP in a 2-year-old female.
• Generally, ITP involves the immune system's destruction of platelets, which are produced in the bone marrow and play a crucial role in blood clotting.
• The anatomy involved includes the bone marrow, spleen, and blood vessels, while the physiology involves the production and destruction of platelets, as well as the clotting cascade.