ZyraDoc #50 - September 20, 2026

A 32-year-old female presents with a 4-day history of spontaneous scattered pinpoint red spots (petechiae) over both lower extremities, easy bruising (ecchymoses), and unusually heavy menstrual bleeding (menorrhagia).

She denies any recent fever, weight loss, joint pain, or new medications, and physical examination is notable only for cutaneous petechiae and mucosal wet purpura without lymphadenopathy or hepatosplenomegaly.

Complete blood count reveals isolated severe thrombocytopenia with a platelet count of 12,000/µL, while hemoglobin, white blood cell count, and peripheral blood smear morphology are entirely normal.

Case Summary

Clinical Focus:

The diagnosis is Primary Immune Thrombocytopenia (ITP).

Aetiology/Cause:

Autoimmune-mediated destruction of circulating platelets, primarily driven by anti-platelet autoantibodies (typically IgG) targeting platelet membrane glycoproteins (e.g., GPIIb/IIIa).
Accelerated platelet clearance by splenic macrophages via Fc receptor-mediated phagocytosis.
Impaired megakaryocyte maturation and inadequate platelet production in the bone marrow due to autoantibody-mediated suppression.

Clinical Features:

Cutaneous bleeding manifestations including pinpoint petechiae, purpura, and large ecchymoses.
Mucosal bleeding including epistaxis, gingival bleeding, menorrhagia, and wet purpura (bullae on oral mucosa).
Absence of constitutional systemic symptoms (e.g., fever, night sweats, profound weight loss).
Absence of splenomegaly or lymphadenopathy on physical examination (presence suggests alternative secondary diagnoses).

Diagnosis and Investigations:

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