ITP workup

 Q; 68 years old recent immigrant from South East Asian region is admitted to ICU with gastrointestinal (GI) bleed. Subsequent workup led to the diagnosis of Immune Thrombocytopenia (ITP) All of the following tests are appropriate on this patient EXCEPT? 

A) peripheral blood smear 

B) HIV 

C) Hepatitis C (HCV) 

D) Helicobacter pylori 

E) Bone marrow examination

Answer: E

Routine bone marrow biopsy is not a part of initial ITP workup, as elderly patients with ITP do not have a higher incidence of myelodysplastic syndrome (MDS). Also, it does not help to identify the cause of ITP. 

Peripheral blood smear (choice A) should be requested to rule out pseudothrombocytopenia due to clumping of platelets. 

HIV (choice B) and HCV (choice C) are now recommended as part of workup for ITP as it can be a presenting sign for both conditions. 

Helicobacter pylori (choice D) should be carried out in all individuals from endemic area due to association between H. pylori infection and ITP.

#hematology

References:

1. Neunert C, Lim W, Crowther M, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011; 117:4190. 

2. Stasi R, Sarpatwari A, Segal JB, et al. Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review. Blood 2009; 113:1231. 

3. Vishnu P, Duncan J, Connell N, et al. International survey on Helicobacter pylori testing in patients with immune thrombocytopenia: Communication of the platelet immunology scientific and standardization committee. J Thromb Haemost 2021; 19:287.

4. Jubelirer SJ, Harpold R. The role of the bone marrow examination in the diagnosis of immune thrombocytopenic purpura: case series and literature review. Clin Appl Thromb Hemost 2002; 8:73.