TY - JOUR T1 - Management of splenic platelet sequestration in idiopathic thrombocytopenic purpura JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000693 VL - 6 IS - 1 SP - e000693 AU - Lindsay Anne Sceats AU - Kelsey Lipman AU - David Spain Y1 - 2021/02/01 UR - http://tsaco.bmj.com/content/6/1/e000693.abstract N2 - A patient in their 40s presented to the emergency department with 3 weeks of diffuse itching, epistaxis, oral ulcers, gum bleeding, petechiae and ecchymoses (figure 1). Medical history was notable for hypertension. The patient denied any recent illnesses, new medications or recent vaccinations. The patient denied any B symptoms including fevers, night sweats or weight loss. Family history was notable for a maternal cousin and uncle with thrombocytopenia requiring intervention.Figure 1 Lower extremity petechiae and ecchymoses at time of initial presentation.Laboratory workup was notable for white blood coun (WBC) 8.7, hemoglobin 17, platelets <2, lactate dehydrogenase (LDH) 275, erythrocyte sedimentation rate (ESR) 33, and Coomb’s direct antiglobulin test (DAT) + (anti-A IgG). Antinuclear antibody (ANA), HIV, hepatitis B and C, and COVID-19 were negative. CT abdomen/pelvis did not demonstrate any hepatosplenomegaly. Peripheral smear was notable for an absence of platelets and increased neutrophils, monocytes and lymphocytes. There was no significant dysplasia or blasts. The patient was treated for presumed idiopathic thrombocytopenic purpura (ITP) with intravenous immunoglobulin (IVIG) and pulse-dose intravenous steroids. The platelet count initially improved, but the response was not sustained, and the patient was transferred to our tertiary … ER -