What is it about?

Multiple bruises in children are either a sign of injury or a manifestation of a bleeding disease. Immune thrombocytopenia (ITP) is the commonest disease that causes a child to be covered with bruises all over the body. The hallmark of ITP is a low platelet count, the little sticky cells that clots up to stop a wound from bleeding. In my practice, there is another group of children who come with a disease that looks like ITP. But their platelet counts are normal, and so are other routine coagulation tests. When the blood cells are seen under the microscope, a peculiar observation is made. These children's platelets are abnormal. They lose their cellular content and thus appear gray. Therefore, I give this condition a name - Idiopathic Purpura with Gray Platelets.

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Why is it important?

Early and accurate recognition of this condition is important: (1) the condition will invariably resolve by itself and the diagnosis is often reassuring to the parents; (2) simple protective measures can be taken to avoid serious bleeding in home and school activities; (3) positive identification of the illness can spare the child from other potentially invasive but unnecessary diagnostic procedures.


A similar condition called Acquired Platelet Dysfunction with Eosinophilia (APDE) has been described in Thailand since the 1980s. However, no precise diagnostic criteria have been described and almost all the reported cases follow what the name APDE implies. The strange thing is that when you look at the scientific reports from Thailand, about 14% of their cases do not have Eosinophilia. Therefore, I suspect that people outside Thailand have been following the wrong lead and thus the condition is rarely described outside Thailand. This paper presents a simple but robust framework to diagnose the condition at the first visit of the affected children.

Dr Anselm C Lee
Mount Elizabeth Hospital

Read the Original

This page is a summary of: Idiopathic Purpura With Gray Platelets, Journal of Pediatric Hematology/Oncology, January 2019, Wolters Kluwer Health,
DOI: 10.1097/mph.0000000000001334.
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