Immune Thrombocytopenia as the Initial Manifestation of Pediatric Systemic Lupus Erythematosus: Case Reports

BACKGROUND: Immune thrombocytopenia (ITP) can precede the onset of systemic lupus erythematosus (SLE) by months to years. CASE PRESENTATION: A 12-year-old girl weighing 46 kg came hospital with complaint 12 days-menstrual bleeding. The patient is weak, pale. Eyes, ENT, heart, lungs, abdomen: within normal limits, no petechiae. Laboratorium: Hemoglobin (Hb) 4.6 g/dL, leukocytes 12,930/uL, platelets 11,000/uL, hematocrit 15%, Diff Count: normal. Red blood cell (RBC) 1.59 million/uL, mean corpuscular volume (MCV) 94.3fL, hemoglobin (MCH) 28.9pg, MCH concentration 30.7%, RDW-CV 14.6%. Corrected-reticulocytes 5.16%, Ret-He 22.6, IPF 54.17%. Peripheral smears normochromic, normocytic, blast not found, are rare. diagnosis menometrorrhagia anemia due bleeding caused ITP. was given PRC and platelet transfusion, methylprednisolone. Three later, had another prolonged menstruation, hair loss, petechiae, or purpura. Hb 8.2 7800/uL, 6000/uL, RBC MCV corrected reticulocytes 5.08%, 24.6, 54.5%. ANA test positive, Anti dsDNA-NcX 190.2 IU/ml. SLE. During last 16 months, took 10 mg prednisone a count >150,000/uL. CONCLUSION: In every case ITP in child, consider possibility