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Trombocitopénia imune em lactente
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A trombocitopénia imune é a causa mais comum de trombocitopénia isolada na criança saudável, devendo-se à destruição das plaquetas mediada por anticorpos. Apresenta-se o caso de um lactente com seis semanas de vida, internado por quadro clínico de equimoses generalizadas, petéquias e hematúria, sem antecedentes pessoais ou familiares relevantes com excepção de história recente de infecção respiratória alta e uso de fármacos como medida anti-cólica do lactente. Analiticamente, verificou-se trombocitopénia grave, com restante estudo sem alterações patológicas. Foram realizadas transfusões de concentrado plaquetário e administrada imunoglobulina endovenosa. A evolução no internamento foi favorável, com normalização do número de plaquetas e regressão dos sinais de discrasia hemorrágica. A investigação etiológica evidenciou anticorpos antiplaquetários nas plaquetas do sangue do lactente, anticorpos anti-HLA classe 1 no soro e plasma maternos, prova cruzada positiva entre as plaquetas do pai e o soro e plasma maternos e anticorpos fármaco-dependentes para um dos fármacos anti-cólica. O caso clínico apresentado é particular por ilustrar mecanismos diferentes de imunização, tendo como singularidades a idade do lactente e os fármacos envolvidos.
Immune thrombocytopenia is the most common cause of isolated thrombocytopenia in healthy children. It is due to antibody-mediated platelet destruction. We present the case of a six-week old infant admitted for generalized ecchymosis, petechiae and hematuria, without any relevant personal or family history except for a recent episode of upper respiratory infection and use of infant colic drugs. A complete blood count revealed severe thrombocytopenia and the remaining study provided no pathological findings. Platelet transfusions and intravenous immunoglobulin administration were the chosen therapeutic scheme. Evolution was favorable, with normalization of platelet count and regression of bleeding signs. Subsequent etiologic investigation showed antiplatelet antibodies bound to the infant’s platelets, class 1 anti-HLA antibodies in maternal serum and plasma, positive crossmatch between the father’s platelets and the mother’s serum and plasma and drug-dependent antibodies for one of the anti-colic drugs. The presented clinical case is unique as it illustrates different immunization mechanisms, while having the infant’s age at onset and involved drugs as singularities.
Immune thrombocytopenia is the most common cause of isolated thrombocytopenia in healthy children. It is due to antibody-mediated platelet destruction. We present the case of a six-week old infant admitted for generalized ecchymosis, petechiae and hematuria, without any relevant personal or family history except for a recent episode of upper respiratory infection and use of infant colic drugs. A complete blood count revealed severe thrombocytopenia and the remaining study provided no pathological findings. Platelet transfusions and intravenous immunoglobulin administration were the chosen therapeutic scheme. Evolution was favorable, with normalization of platelet count and regression of bleeding signs. Subsequent etiologic investigation showed antiplatelet antibodies bound to the infant’s platelets, class 1 anti-HLA antibodies in maternal serum and plasma, positive crossmatch between the father’s platelets and the mother’s serum and plasma and drug-dependent antibodies for one of the anti-colic drugs. The presented clinical case is unique as it illustrates different immunization mechanisms, while having the infant’s age at onset and involved drugs as singularities.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Trombocitopénia imune primária Púrpura trombocitopénica idiopática Trombocitopénia induzida por fármacos Trombocitopénia neonatal aloimune Pediatria