CONTROLLING THE UNKOWN

INTRODUCTION and OBJECTIVE Idiopathic thrombocytopenic purpura (ITP) is characterized by a reduction of platelets of unknown origin, secondary to excessive destruction of platelets by immunological factors. Common in women of childbearing age, it may be asymptomatic or have hemorrhagic manifestations. The causes may be infectious, neoplastic or autoimmune diseases. Antiplatelets antibodies may be present. The GP has a major role in the detection of the symptoms and should be available for regular reviews. METHOD Clinical consultation and case report. RESULTS and CONCLUSIONS Female, 29 years old, family classified as a nuclear family in the II stage of Duvall lifecycle. History of hyperthyroidism and thrombocytopenia 7 years before (with negative complementary study). Consulted by the GP due to bruising, melaena and epistaxis with 1 week of evolution. Urgent analysis were requested and revelead 46.000 platelets, being the patient referred to the urgency service. Further investigation was requested - thyroid function (normal), serology (negative), autoimmunity study of anti-ANA + antibodies (1/160 mottled pattern) and antiplatelets antibodies (negative). After a bolus of methylprednisolone, she was discharged, with 104.000 platelets, and referred to Hematology. She was observed four days later by the GP due to metrorrhagia. Analytically, platelets were 75.000. She was prescribed prednisolone 40mg/day. She was consulted by Hematology 2 months later and diagnosed with ITP. Having a cushingoid facies and 362000 platelets, she began weaning steroids. The family doctor plays a central role in the evaluation and management of patients with chronic diseases, needing to be accessible to regular and urgent observation.