TOPIC: Almost 5 year old daughter newly diagnosed with ITP

Hello,
First I would like to thank all the people who have posted on this about itp. It has helped me a lot in this helpless journey we are in.
On August 27th, 2018 my daughter got the booster mmr shot (I mentioned to the doctor that she had had some diarrhea and wasn’t feeling great before she administered) the same day we got her annual blood test for her 4 year old well visit. A few days later I got a call stating that her platelets seemed low and that we should visit the hematologists regarding this. Even though the doctor mentioned we shouldn’t be too worried because they weren’t dangerisly low I began my google mania. The things I was reading were terrorizing me until I pinpointed to ITP. Meanwhile I made an appointment to the hematologist but it wasn’t for another month. Long story short my baby girl got sick with a fever. I gave Tylenol but then switched to Motrin big!! Mistake next morning she woke up with red dots all over her (petechia) her pediatrician advised us to rush to the hospital her platelets dropped to 8,000. The pediatric hematologist advises we do ivig and so we did as they said because anything under 10,000 is dangerously low and can lead to severe bleeding. Before they started ivig they gave her Tylenol and Benadryl to brevet her fever from spiking. 2 bags of ivig was given with constant monitoring for fever. We were discharged after 2 days. After that we were getting weekly blood tests with normal platelet level counts. her levels stayed up until a few weeks ago she got a low grade fever and we noticed a petechia on her belly. Nov 6th Back for blood test they had dropped but nothing too low (101) the next test they went even higher than that. Just when we thought we were doing great for a few weeks after that on Monday November 26th we went for our weekly blood test it comes back 5,000 we rushed to the hospital and had another round of ivig but were discharged after 8 hours (as soon as the ivig finished) waiting for Friday’s blood test to see results but today she has had a fever so we took her to the pediatrician it’s just a cold but it seems whenever she gets a little sick her levels just plummet.

Anyone have advice or similar experience? I’m so scared and cannot see the light at the end of the tunnel. My heart aches with the idea that my almost 5 year old active daughter will never be able to be normal go to gymnastics and run at the park again. I’m trying to be strong but I cannot help feeling helpless. Should I go get a different opinion?

Thank you in advance for any information you may have to offer.

For what it's worth Turbo, the statistics for children are pretty good. For children something like 60 to 80% of ITP cases self resolve in less than 6 to 12 months. I think there is another statistic that says a low counts (typ for row 1 or 2) like that portends a good prognoses percent as well. Not sure.

I do notice you have included 3 possible triggers. MMR vaccine, Motrin, and Flu. The way things seem to be coming and going, Flu looks pretty guilty to me. I suppose MMR and Flu combination is pretty possible too. I've done searches on this board for MMR before. I think your story is a first in this regard. If you're seeing a children's hematologist, maybe they have a better feel and knows how MMR vaccine triggered ITP plays out. Comes and goes, or is constant.

As for a second opinion. Didn't hear anything in your story that would suggest that. You might take a look at the 'childrens' section of this paper for more info. Notice that it is published by ASH, aka American Society of Hematology.
asheducationbook.hematologylibrary.org/content/2011/1/384.full

Thank you for your fast response.

The Mmr from what I have researched can be a trigger, her hematologist thinks that in this case it wasn’t the cause because the same day she got the booster mmr she had her blood drawn and her platelets were low. She doesn’t think that platelets would drop so low within a 2 hour span. Unfortunately because there are combinations of possible triggers one being that in early July she had strep etc we just cannot pinpoint what exactly caused this. What I can say for sure is that whenever she gets a cold or virus her levels drop fast. The first time she was hospitalized and got the ivig treatment the hematologist ordered a viral panel (swab in the nose) that indicated she had a virus (even though it took a week for us to get the results). So this Monday which was exactly 2 months after her first ivig her levels dropped to 5,000 I requested another virus panel to be done. As soon as I get the results I will write an update on here.

You mentioned that you read that when levels are so low there is a better prognosis. Do you recall were you found this info? If not it’s ok it did give a tiny bit more hope.

Thank you Hal9000!!

Ah, ok. Counts were already low before MMR.
For lack of anything better to suggest, does she take a children's vitamin? I've learned from my ITP experience that there are a number of vitamins that need to exist for our immune system to be most effective. Being effective in deciding what is, and what is not, foreign. I could harp about a B-complex vitamin, but I won't, LOL.

On the low counts. A form of the statistic was actually in my earlier link. Here is the specific sentence.
"
The 5%-10% of children who develop chronic ITP tend to be older, are more often female, and usually present with a higher platelet count.
"
I think it goes like this. She's younger and has lower counts - so that is working for her. But she is female - and that is working against her.

She does take a children’s multi vitamin.

Please boast about the Bcomplex vitamin I’m interested to learn more and desperate to do anything to help her recover and keep those counts up.

What I was thinking was Folate, Vitamin D, Zinc, and Selenium.
In my own efforts here, there seems to evidence that the Flu with a Folate deficiency may be a ITP trigger. Vitamin D seems to stimulate the 'innate' part of the immune system to fight the Flu. Small amounts of Zinc and Selenium are known to help with T cell cloning/proliferation. Probably getting enough of those with a multi vitamin. I think if one is vegan/vegetarian the list is longer. Not familiar with that.

What do you think, have I left any out?

Turbo, hi. Hal has given you a lot of good information. Quick onset, very low numbers at diagnosis, and young age are all working in favor of your daughter being an acute case. However, even if chronic, your daughter will likely be able to live a normal life. It does take time to learn how to deal with ITP and I know it's not easy.

One of the best researchers on childhood ITP is by the lead author if this study: www.bloodjournal.org/content/124/22/3295?sso-checked=true

You can find a lot of related studies and summaries of studies that will have similar conclusions.

www.bloodjournal.org/content/124/22/3295?sso-checked=true

You can check out my son's story by clicking on my profile and then navigating to the thread about my 3-year old. It took him a good 4 months just to cross the 100,000 line without the help of IVIG. It's not uncommon for counts to drop any time a kid catches a virus, until the body figures out that platelets do not equal the virus.

Here is an update just as I suspected when we were hospitalized last week I requested a viral panel as the first time she had a virus. Yet again this time RSV came up. I’m walking on egg shells every time she gets a little sick to the point I don’t know if sending her to school is benefiting her or not.

Thank you for your response Maria and Hal.

Maria how long has your little one’s numbers been at a normal range for?
My daughters go to normal and once she gets sick they plumate. I mean from one week they are over 150,000 and the following week they drop to 5,000. I read in one of the threads that your sons levels were always staying low did you do anything to help them go up?

Turbo, we only did ivig when levels dropped below 10,000 and I gave him papaya but I can't be sure if that's what helped. His doctors said it wouldn't be unusual for platelet numbers to plummet with new infections until his body figured it out. You can read the play by play in my thread: pdsa.org/discussion-group/6-general-itp-discussion/30129-petechiae-but-no-bruising-in-3-year-old.html

I think the fact that drops correlate with viral infections is an encouraging factor for your daughter.

Try not to put the horse before the cart. Many children end up having acute ITP. It's frustrating at first but does get easier. Just try to take one day at a time. There is a lot of hope!

Your daughter can go to gymnastics and run around like a normal child when her counts are good. When they are above 50k, take full advantage of that and let her have fun!