A 28-year-old woman from Delhi presents with a 3-day history of severe epistaxis and gum bleeding. She has a history of easy bruising since childhood. On examination, petechiae are noted on the lower extremities. Laboratory investigations reveal: Hb 9.2 g/dL, platelet count 8,000/µL, PT 12 sec (normal 12–14 sec), aPTT 32 sec (normal 24–36 sec), bleeding time prolonged. Bone marrow examination shows normocellular marrow with adequate megakaryocytes. What is the most likely diagnosis?

Clinical Presentation & Diagnosis

This patient presents with severe thrombocytopenia (8,000/µL) with a long history of easy bruising and mucocutaneous bleeding, but normal coagulation studies (PT, aPTT) and a normocellular bone marrow with adequate megakaryocytes. These findings are pathognomonic for Immune Thrombocytopenia (ITP).

Pathophysiology

Diagnostic Criteria for ITP

Why This Patient Has ITP

High-Yield Mnemonic

"ITP = Isolated Thrombocytopenia with Preserved coagulation" — when you see low platelets + normal PT/aPTT + normal fibrinogen + adequate BM megakaryocytes, think ITP first.

Clinical Pearl

Bleeding time is prolonged in ITP because platelet count is so low that platelet plug formation is impaired, even though individual platelet function is normal. Modern labs have abandoned bleeding time; diagnosis is clinical + platelet count + BM exam.

Management Approach

Robbins 10e Ch 13

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