Immune thrombocytopaenia is a condition characterised by isolated thrombocytopaenia, with diagnosis being particularly challenging in cases with concurrent cirrhosis and portal hypertension. This is an unusual case of a gentleman presenting with an acute gastrointestinal bleed on a background of liver cirrhosis with atypical underlying pathology contributing to the bleeding. They were found to have immune thrombocytopaenia and coexistent gastric antral vascular ectasia, which posed unique therapeutic challenges. This case raises the importance for clinicians to maintain a high index of suspicion for multiple pathologies contributing to the presentation of an acutely unwell patient and to be aware of the role clinical bias can play.
Alex Harker (Sun,) studied this question.