The Doctor Will See You Now [Non-Fiction]

Chapter 78: General Medicine

Surgery has sent a request for a medical consultation for one of their inpatients, Jean, a 65-year-old woman admitted to hospital for abdominal pain and fever. Her platelets were on the low side at 122 (x10^3), with normal being 150-400 (x10^3), but during the few days admitted to surgery and given antibiotics for septicaemia (her blood culture has grown a bacteria), her platelet count had fallen to the single digits requiring multiple platelet transfusions. At single digits of platelet count, she is at risk of sudden intracranial haemorrhage.

Many things can cause low platelet count, including severe infection, bone marrow disorders, drugs (including many antibiotics), a big spleen, rheumatological conditions etc. For some reason, the surgeons decided she has ITP (immune thrombocytopaenic purpura, an immune-related disorder whereby the body destroys its own platelets, often with an unknown cause) without much investigations and has started her on high-dose steroids. Even though ITP is a diagnosis of exclusion (meaning all other potential causes must be excluded as a way of 'confirming' ITP). And she has sepsis (infection of the blood) -- and steroids suppress the immune system. And, because she has type 2 diabetes on insulin, her blood sugar has rocketed thanks to the steroid.

I take over Jean's care onto the medical ward before the surgeons kill her by suppressing her immune system when she still has ongoing sepsis.

She spends a month under my care, during which she has an extensive array of tests done, including cancer markers, autoimmune blood tests, a bone marrow aspiration exam, and an ultrasound of her abdomen. Because the results take up to one or two weeks to return and her platelets remained persistently in the single digits during this period, she had so much platelet transfusions that she bled the blood bank dry (pun intended).

In the end, because all her results came back negative, Jean's diagnosis was ITP after all. We gave her high dose steroids in the end and her platelets improved to the point where we could discharge her without worries of her suddenly haemorrhaging into her skull.

I guess a broken clock is right twice a day.