Stroke in a Pediatric Immune Thrombocytopenia Case

Objective: Immune thrombocytopenia is a bleeding disorder related to deficiency of the main element in primary hemostasis, platelets. But it rarely results in an opposite clinical complication as thrombosis. The mechanism of this unexpected complication is not fully understood still and the treatment of the patients in this thrombocytopenic and thrombotic condition is critical and hard to manage. Here we present a case of immune thrombocytopenia with cerebral infarct with his clinical management details.

Case: A seven-year old boy diagnosed with Immune thrombocytopenia at the age of 1 in another clinic and treated with IVIG when the platelet levels fell and bleeding symptoms appeared. The patient refered to our clinic with severe refractory thrombocytopenia. After being diagnosed with ITP, IVIG treatment and HDDXM treatment (20 mg/m2/day for 4 days) was given 2 cure in a month then the patient follow up in the clinic. It is learned that the family continued with HDDXM and sometimes IVIG treatment when needed in the local hospital. When the child was 6 years old, because of inability to walk and talk he was referred and it was revealed that he had cerebral infarct in the ICA area with a platelet level of 11000/mm3. He was followed in pediatric ICU. He was treated with thrombocytopenia with replacement and steroids in addition to physical treatment for stroke. Anticoagulation was used as the clinical and laboratory picture allowed.

Result: The patient was discharged with the better clinical Picture and his chronic treatment planned mostly with steroids.

Conclusion: Stroke in the immune thrombocytopenic clinic is a rare but hard to manage condition. Although its mechanism not understand well, the clinician should be identify and manage it carefully.