Patient A
An 11-year old female was referred to the pediatric hematology clinic
for isolated thrombocytopenia, which was identified after presenting to
the emergency department with bilateral toe bruising. Her fingers and
toes would become purple for a prolonged period of time, but bleeding
symptoms were absent.
Family history was positive for bruising in the mother and anemia in the
maternal grandmother. The patient was taking atomoxetine, risperidone,
hydroxyzine, and medroxyprogesterone acetate. Physical exam showed
cyanosis in the feet after exposure to cold, slow capillary refill, and
macular papular red erythematous rashes above the ankles bilaterally.
Complete blood count (CBC), screening coagulation studies, serum
immunoglobulins, and autoimmune studies were obtained (Table
1 ). Mild thrombocytopenia with normal sized platelets and normal
granulation on peripheral smear was noted. The clinical presentation was
most consistent with Raynaud’s, and it was thought that the mildly
decreased platelets could have been the result of viral suppression or
side effects from risperidone. A repeat CBC one month later was
recommended.