6.5 month old with ITP, low RBCs and WBCs

Hi All,

My 6.5 month old son was recently diagnosed with ITP after his platelets dropped to 2,000. He received an IVIG transfusion and has responded well to it. However, his RBCs, hemoglobin, hematocrit, and neutrophils remain very low and have not responded at all to the IVIG. Has any one dealt with low blood counts across the board with ITP? I thought that a characteristic of ITP was only low platelets and normal WBCs and RBCs. I feel like at this point, my son's hematologist might be guessing as to what she thinks might be wrong with him since he's had absolutely to infections, bleeding, fever, or any physical attributable illness to low blood counts. She's ruled out aplastic anemia and leukemia on the basis that "he doesn't look sick enough." I'm definitely getting a second opinion but have the appointment in 2.5 weeks. I was just wondering if anyone else has dealt with low blood counts across the board with ITP. I have a feeling this could be something else...

Yes, ITP is just concerned with a low platelet count, however there is something called Evans Syndrome which is the corresponding autoimmune disorder affecting two or more low blood lines. But your son needs a full workup looking for everything else before they come to that conclusion.

Has he had a bone marrow biopsy? That would be the first thing to do.

I would also urge you that if your son gets a high temperature to take him to hospital immediately as neutropenia can cause the body to be overwhelmed quickly.

The second opinion is a good idea. I wouldn't be comfortable with the fact that she is ruling out other disorders based on how he looks. ITP is based on low platelets only. If his red and white counts are only borderline low it might not be anything to worry about, but I'd let a second Hemo make that decision.