Rare cause of bleeding in a young footballer

Excerpt

A 12-year-old male soccer player had a 1-week history of injury to the left lower leg. He was playing football and was involved in a collision with another player. He was wearing shin guards. He was referred to the fracture clinic with a large haematoma on the anterior surface of his left tibia, which measured 12 × 10 cm; skin was intact and distal pulses were intact. Plain X-rays were normal. Ultrasound indentified a well-defined non-homogenous haematoma. There was no clinical evidence of compartment syndrome. With these results, it seemed that this was an excessive response to an injury; as such, further investigation was undertaken. A full blood count and blood film identified thrombocytopenia (platelet count 22 × 10⁹/L). Additional investigations undertaken included coagulation screening; renal and liver profiles; vitamin B₁₂, folate and iron studies; coeliac screening; and thyroid function tests. These were normal. He had no petechiae or other constitutional symptoms. There was no evidence of recent viral infection (EBV or parvovirus) to suggest post-viral bone marrow suppression. He had a history of a similar previous injury 2 months prior to this presentation. His mother felt that he bruised easily. He experienced frequent epistaxes (one to two per month). These were not particularly heavy and were relieved by pressure alone. He had no past gum bleeds and no prior surgery. His past medical history included hay fever and G6P deficiency. No relevant family history was described. He had not required medical attention prior to this presentation and was not on any medication or herbal remedies. He remained well whilst an inpatient under observation. Subsequent repeat full blood counts demonstrated a fluctuating thrombocytopenia. A diagnosis of chronic immune thrombocytopenia was made. Conservative management was sufficient in this case. A 4-day course of prednisone was used to increase and stabilise his platelet count before being discharged. Swelling resolved over 2 weeks with physiotherapy. Recovery was uneventful. Both the patient and his family were advised that any future surgery, dental procedure or serious trauma would require consultation with a haematologist. Patient remained well at follow-up 1 year later and has returned to sport. …