About three weeks ago, we noticed that Peter had a strange rash on his hand - purpleish-red dots about the size of a pinhead. At the time, we though it was heat rash and it went away in a couple of days. Then we noticed it again on Sunday when he hadn't been out in the heat at all. On Monday the spots started cropping up elsewhere - on his head and face, around his ankles, on his belly. I was not worried about them ("Oh, they're fine. They went away last time.") but Elisa was, so she took him in to the pediatrician. We are both very glad she did. It turns out that the little spots were not a rash, but small ruptured blood vessels (called petechiae) that were making tiny bruises. The pediatrician did a blood test on him and his platelet count was very, very low - Peter had only 3,000 platelets/µL of blood and a healthy person should have around 200,000/µL. The low platelet count means his blood has trouble clotting, explaining the bruises.
The pediatrician told us to take him to the ER at children's hospital immediately, which we did. He has been in the hospital ever since undergoing various tests to try to determine the cause of his low platelet count. We still don't know what is causing this, but there are a few things we do know:
1) Peter is not in any immediate danger. All the doctors (and there have been many, as it appears attending physicians like to consult on cases that involve a cute baby :-) agree on this point. Peter's condition is medically known as Thrombocytopenia Purpura (TP), and while that sounds scary, it is typically not life threatening. In the majority cases, the problem resolves itself, never recurs and there are no long-term aftereffects.
2) Peter is not in any significant pain. He's still just a normal baby - loves the mobile over his crib, smiles when he sees Mama or Papa, doesn't fuss more than normal. He's OK. Probably his biggest problem is that doctors keep sticking him with needles to draw blood for more tests. <smiles>
3) It is very unusual for a baby this young (3 months) to have TP. I'll talk more about this in a second, but the most common cause for TP is an autoimmune response - the body mistakes the platelets for bacteria and starts killing them off. The reason this is unlikely for Peter is that he is breastfeeding - thus, he gets his antibodies from Elisa. The logic goes that because Elisa doesn't have TP, Peter shouldn't either.
The main reason the doctors are keeping Peter in the hospital is #3 - they want to figure out what is causing this before they try to treat it and/or release him. Elisa commented that meeting with the doctors is kind of like watching House, because they will pepper her with questions (Has Peter had flu-like symptoms in the last 6 weeks? Are you on any medication? Have you ever been to the south of Greece? ...) trying to come up with a potential link. Thus far, no link has turned up and after 6-10 different blood tests, the only anomaly is his platelet count. There are two possible explanations for this:
A) It might be an autoimmune response. In this scenario, his body is making plenty of platelets, but they are getting broken down either in the blood stream or in the spleen. If Peter was even 1 year old, this would be the default diagnosis. However, because he's so young, the doctors are a bit suspicious. Things are complicated by the fact that it is impossible to detect this - they only make this diagnosis by excluding all other possible causes. In any case, if this is Peter's problem, the prognosis is quite good. In 90% of immune TP (ITP), the immune system eventually re-sets itself and the patient recovers.
B) Alternatively, Peter's bone marrow might not be producing enough platelets. There are a number of ways this can happen. Based on Peter's test results, the most likely of these conditions is called amegakaryocyte TP (ATP). The doctors don't think this is likely (one physician commented that of the thousands of patients he has seen, he's never seen a case of ATP). However, if this is the problem, the treatment would need to be more aggressive (e.g. a bone marrow transplant).
In order to try to decide between these two options, the doctors put Peter on an immune suppressant (immune globulin, IG) last night. The idea is that if it is an autoimmune response, the IG should suppress it and allow the platelets to survive longer, elevating his platelet count. They've scheduled another round of tests for tomorrow morning to see if this works. In the meantime, we just wait and pray. If the IG works and his platelet levels are higher (we're praying for 20,000) then it's probably ITP and Peter will be able to come home. He would probably need to have some more IG treatments, and they might want to do periodic tests, but this would be our best-case outcome at this point. If his platelet counts are still low in the morning, then the doctors will do a bone marrow draw tomorrow afternoon to test for ATP as well as a few other potential problems.
All things considered, I think Elisa and I are holding up pretty well. When I look at it and think "it's been two days and we still have no idea what is wrong with our son," it seems like we should be really anxious. But we are not. I mean, each of us has times where we just need a good cry, but overall we've been at peace. It probably helps that Peter has been very calm through everything. I also probably helps that Lydia _loves_ staying with her friends ("Can I have a sleepover at Faith's house? Can we go to Kia's house now?") But it also helps that we have so many friends and family who love us and are praying for us. So thank you for your support.
OK. Time for me to get some sleep. I'll try to post tomorrow to let everyone know how the tests turn out, but it may not be until the evening. In the meantime, please join us in praying that Peter's platelet count would go up.
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