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J Athl Train. 1998 Jul-Sep; 33(3): 269–270.
PMCID: PMC1320436

Idiopathic Thrombocytopenic Purpura Presenting in a High School Football Player: A Case Report

James C. Leonard, MD and Mark Rieger, MS, ATC/L, CSCS

Abstract

Objective:

To alert athletic trainers to the signs and symptoms of idiopathic thrombocytopenic purpura and its clinical presentation in order to facilitate immediate intervention.

Background:

Idiopathic thrombocytopenic purpura (ITP), also known as immune thrombocytopenic purpura, is a hemorrhagic disorder that is primarily immunologic in origin but is sometimes triggered by viral infection in children. It has also been associated with heroin and quinine drug use. A reduced platelet count can result in mucosal or deep tissue bleeding, or both, and most importantly, intracranial bleeding. Because football is a collision sport, it is imperative that any player presenting with ITP-type symptoms be removed immediately from all contact and referred to a physician.

Differential Diagnosis:

Leukemia, aplastic anemia, drug side effects, vitamin deficiency, kidney failure, infection, multiple contusions.

Treatment:

The traditional first-line treatment consists of corticosteroid medication and time and removal from all physical activities until the blood platelet count is normal and controlled. In quinine-induced ITP, discontinuation of the drug and bedrest are recommended to reduce the risk of major hemorrhage for a 12-to 14-hour period in order to allow the quinine to clear the system and the platelet count to return to normal.

Uniqueness:

ITP's presentation needs to be differentiated from other disorders. Incorrect diagnosis could seriously jeopardize the athlete, who could develop intracranial and internal bleeding.

Conclusions:

Recognition of the signs and symptoms associated with ITP is essential to prevent further participation by the athlete. Immediate intervention is needed to determine the severity and to institute appropriate treatment.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (371K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.
 
 

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Rutherford CJ, Frenkel EP. Thrombocytopenia. Issues in diagnosis and therapy. Med Clin North Am. 1994 May;78(3):555–575. [PubMed]
  • George JN, el-Harake MA, Raskob GE. Chronic idiopathic thrombocytopenic purpura. N Engl J Med. 1994 Nov 3;331(18):1207–1211. [PubMed]
  • Powell SE, O'Brien SJ, Barnes R, Warren RF, Wickiewicz TL. Quinine-induced thrombocytopenia. A case report. J Bone Joint Surg Am. 1988 Aug;70(7):1097–1099. [PubMed]

Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association