3 yr old boy - not much improvements in platelets

My son has been a healthy child with no prior history of ailments, hospitalization or medication. He did not have any fever, cough or took any king of medicines for the past 3 to 4 months before the first diagnosis. He eats well, plays well, sleeps well and his development has been normal with up to date immunization.

He was first diagnosed with ITP on October 14th when his platelets were <2K. From there on it has been an interesting ride. Here is a brief history

First diagnosed on Oct-14 with a Platelet count of2K. Treated with IVIG overnight. Next morning (Oct 15) counts climbed moderately to 5K and 13K on Oct 17.

Apparently it did not show the affect doctors were hoping for and then the platelets dived again to 3K on Oct 20th. We followed him with another dose of IVIG treatment

His counts were checked next on Oct 26 and they had dropped (I say dropped since I assume they might have increased sometime in the week - no symptoms) to 6K.

This time the doctor started him on Dexamethasone (25ml per dose, 2 dose per day for 5 days). His follow up counts went to 35K on Nov 2nd. Doctor put him off meds for a week to see if this will sustain but his next counts were 3K on Nov 8th

One more dose of Steroid - Dexamethasone (25ml per dose, 2 dose per day for 5 days). This dose might have helped but on the day of counts were low again on Nov 16th

Meanwhile the doctor had put In a request for Promacta which got approved. He is on Promacta since Nov 15th (25mg pee day)
2 weeks of Promacta – test results 2K on Nov 20th and 5K on Dec 14th.
We have increased his dosage of Promacta to 37.5 mg per day and waiting for the next test on Dec 28th

He keeps getting this mild petechiae on his upper body every two three days which go away in a couple and then we see new ones in a new place.

With God’s grace and mercy my son has not had a single episode of bleeding with these low counts but we are very worried as the meds are not helping push the counts up in the short term too.


What do you guys think?

Sorry realized this should have gone on the Parents of Children with ITP section. Moderator can you please help move the topic there?

Yes, I will move it.

ITP can sometimes appear after vaccinations...did your son have any in the weeks or months prior to ITP?

ITP is frustrating because it can take time to see results with treatments. Obviously, IVIG and Dex didn't do the trick, but I'd give Promacta more time. Many times, doctors will not treat children if symptoms are few, so watch and wait can be a valid option.

Hang in there. It can take some patience!

How did you find out at the first place? If he has no symptom, is it possible the count was already low several months ago, and he might have some medicine/vaccine at that time?

Yea, in my humble opinion, if it was caused by a virus or virus immunization that could lead to a good prognosis. The virus is now gone and his immune system might be kicked, through therapy, back into normal behavior (stasis). Or even, all by itself. Hence the statistic that most childhood ITP will remit.

Looking on the bright side, Promacta will give his immune system time to restore normal function. Kicking/shocking it hasn't seemed to work.

Good luck...

Thank you @Sandi for the reply. He was diagnosed when he was around 3 yrs and 7 months. The last vaccination he had was at 3 yrs. So no, no vaccination nor any symptomatic viral infection in the couple of months before he was diagnosed.

I guess for now it is wait and watch with the medication. Wife and I were discussing that meds have had no effect on the platelets in the 10 weeks, may be he would have been better without. But then how would one know?

Thank you @tj1989 for writing. We started seeing some bruise on his body 10 days before his diagnosis. Thought it might be some accident but then saw around 5 to 6 bruises in the coming week. Went to the doctor, who asked for a CBC and then is when we got diagnosed with low platelets.

Doctor is saying he is classic ITP. All other counts (RBC,WBC, hemoglobin) have stayed stable.