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Greetings, PSUEngineer, your daughter sounds like a very active, dedicated young woman who might be hard to sideline! What are her thoughts about her own circumstances?

A head injury or splenic injury are the two biggies, with the splenic injury being the more likely of the two since the spleen, though under some ribs, is not encased in a bony shell as is the brain. Young people after a bout of mononucleosis are advised to avoid contact sports for an interval because the virus results in enlargement of the spleen, thus becoming temporarily more fragile. In ITP the platelet count is low - if I recall correctly, the platelets are replete in the marrow but get sequestered in the spleen (taking them out of circulation) and there is a similar splenic effect of enlargement and fragility. Sometimes this resolves and sometimes it doesn't (probably depending on the chronicity of the condition). An abdominal ultrasound can help confirm it but a large enough spleen can often be detected on physical exam in a thin young person.

Was her doctor opposed to steroids because of the effects on developing bone?

I don't think the answers are easy. A splenic bleed, especially due to a rib fracture, can be catastrophic and swift (a head bleed often hides for an interval) and the clock is your enemy when it comes to facing emergency splenectomy in this case. Oral contraception sounds sensible here but is there any gear that would help cushion a direct blow to the spleen?

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