A 5 year old child presents with history of fever off- and-on for past 2 weeks and petechial spots all over the body and increasing pallor for past I month. Examination reveals splenomegaly it 2 cms below costal margin. The most likely diagnosis is (AIIMS Nov 2012)
|B||Idiopathic thrombocytopenic purpura|
a. Pallor (anemia), petechial spot (thrombocytopenia), fever (infection due to neutropenia) with splenomegaly suggest the diagnosis of acute leukernia.
b. Further, presence of splenomegaly eleminatessplasticanemia and ITP as the possibilities
"splenomegaly and lymphadenopathy are extremely uficommon in ITP and their presence should lead one to consider other possible diagnosis". – Robbinb "Splenomegaly is chqrqcteristicqlly absent tu aplastic anemia and if present the diagnosis of a plastic anemia should be seriously questioned.
c. Hypersplenism' is a condition characterised by splenomgally and cytopenias with a normal hyperplastic marrow arrd response to splenectomy. Although cytopenias resulting from hypersplenism may give rise to most mardfestations mentioned in the question these are more likely with massively enlarged spleens and not with minimally enlarged spleen as in the question above (2cm below costal margin in a 2 year old child).