John was a blue-eyed, blond 12 year old kid. He was visiting grandma with his family in late summer. John and his two sisters had gone out in canoes somewhere off the New England coast. Unfortunately, the tide went out on their way back to shore. John and the girls had to drag the boats across the mudflats to return. It wasn’t easy. John only had flip flops and pretty soon, sscchhlurp! one of them got sucked into the mud. Now he had to continue with only one flip flop. Suddenly, ‘ouch’ John had stepped on something sharp. It must have been a shell fragment or a neglected bottle cap. The wound on his heel bled profusely. It seemed the bleeding lasted for longer than it should have. With pressure, finally the bleeding stopped and they all made it back to shore safely. The next day John came to our Wound Healing Center.
After hearing the story, I was concerned about possible contamination of marsh mud to the wound. Under the bright lights of examination, I could see the wound actually wasn’t that bad at all. It was a small injury, clean appearing with out any signs of infection. What caught my eye, however, were many small red dots in the skin over the whole lower leg. I looked at the other leg and noticed the same thing. These were ‘petechiae’ – small hemorrhages within the skin. The parents then gave further history – he had frequent nose bleeds and tended to bruise easily. John must have some sort of platelet disorder. That would explain his prolonged bleeding episode. We patched up his wound and sent him for blood work.
The results revealed John’s platelet count had dropped to a dangerous level – 5,000 platelets per microliter. John would need platelet transfusions urgently to prevent any internal bleeding. He had ITP or idiopathic thrombocytopenia purpura. This was a little understood disease where platelets are destroyed by the immune system. The disease had to be stopped from progressing. He was given IVIG (immunoglobulin) which served to temporarily halt the consumption of platelets. Later he would be treated with immunosuppressive medication for longer term control.
Now John’s platelet count has improved and the danger has passed. I think of how lucky he was to travel to grandma’s and then step on that sharp shell! It seemed to be more than a just a coincidence…