There’s a bizarre-o disease called idiopathic thrombocytopenic purpura (ITP)–a.k.a. an abnormally low platelet count (thrombocytopenia) of unknown origin (idiopathic) that causes, among other things, red-purple splotches on skin (purpura). For some reason, when it occurs in young children, it often resolves itself readily, and interventions are seldom required. Still, it’s somewhat terrifying to send a kid home with a soft helmet and instructions to try not to run into anything, who has a platelet count of 2 (I’m not exaggerating), when the normal count should be 150,000-450,000.
We’ve had a number of otherwise healthy kids with ITP during my brief time on the pediatric hematology service. I was examining/playing with one of them today and, as I was placing him back into his crib, the edge of my stethoscope got caught on his shift sleeve, and he banged the back of his head on the railing. He cried for about a second before he realized that he wasn’t hurt–this was the type of bump that most infants/toddlers experience probably multiple times a week/day without any problem. But this kid can’t quite clot correctly with a negligible platelet count. So, though I tried to remain calm and cool (yeah right) on the outside, I was thinking to myself, Oh God, this kid is going to develop of huge hematoma on the back of his head…forget that! He’s going to BLEED INTO HIS BRAIN! Oh my god oh my god oh my god!!!
I carefully examined between his hair and around his neckline for any signs of bruising, told the mother I would check in with them soon and asked her to let us know if she noticed any bruising, and asked his nurse to do the same. I felt somewhat reassured that the mother, who was as loving and doting as they come, was unconcerned, and her son truly did seem completely fine.
A half hour later, his nurse soberly approached me, “Can you come take a look at K’s head? The bruise seems to be expanding quite quickly.” I must have turned white as a ghost as I rushed to his room. His mom, holding her giggling bruise-free son, met me at the door, unable to contain her laugher, at which point the nurse cracked as well, “I’m so sorry…it was just so easy!”
So I haven’t killed any children in my first two weeks of Peds.
anna in med school 