Easy Bruising, Cataracts, and Hearing Loss in a 27-Year-Old Female

Alexandra Harrington, MD, MT(ASCP); Patrick C. J. Ward, MB, BCh; Steven H. Kroft, MD


Lab Med. 2008;39(1):20-22. 

In This Article

Clinical History

27-year-old female.

Easy bruising.

The patient presented to the hematology clinic for evaluation of lifelong easy bruising and thrombocytopenia. As a child, she was diagnosed with immune thrombocytopenic purpura (ITP), which was apparently refractory to both medical and surgical interventions. In the past, however, platelet transfusions had successfully raised her platelet counts prior to surgery.

Presumed ITP refractory to corticosteroids, Rituxan, WinRho, plasma exchange, intravenous immunoglobulin (IVIG), and splenectomy; end-stage renal disease secondary to Alport's syndrome, status post related donor kidney transplant; diabetes; hearing loss; cataracts.

Unknown, as the patient is adopted.

Vital signs: temperature, 99.6B0F; pulse, 94 bpm; respiratory rate, 12 rpm; blood pressure, 137/83 mm Hg. The patient was obese and cushingoid (eg, buffalo hump, obesity, striations). Skin examination revealed a bruise on the right upper extremity and multiple abdominal bruises at insulin injection sites. A left upper quadrant scar, consistent with a splenectomy scar, was present. There was no hepatomegaly, lymphadenopathy, or petechiae.


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