A 35-year-old woman presents with spontaneous bruising, epistaxis, and a positive tourniquet test. Platelet count is 8,000/μL. Coagulation studies (PT, aPTT, fibrinogen) are normal. Bone marrow shows adequate megakaryocytes. What is the most appropriate immediate next step in management?

Question

Accepted Answer

C. Start intravenous immunoglobulin (IVIG) and corticosteroids. ## Clinical Diagnosis This patient has **Immune Thrombocytopenic Purpura (ITP)** — characterized by thrombocytopenia with normal coagulation studies and adequate megakaryocytes on bone marrow, indicating immune-mediated platelet destruction. ## Management Algorithm for Acute ITP ```mermaid flowchart TD A[Platelet count < 20,000 with bleeding]:::outcome --> B{Steroid response expected?}:::decision B -->|Yes, first-line| C[IVIG + Corticosteroids]:::action B -->|No/refractory| D[Consider rituximab, TPO agonists]:::action C --> E{Response in 2-4 weeks?}:::decision E -->|Yes| F[Taper steroids, maintain]:::action E -->|No| G[Splenectomy or alternative agents]:::action ``` ## Key Point: **IVIG + corticosteroids are first-line for symptomatic ITP with platelet count < 20,000/μL.** IVIG works within 24–48 hours by blocking Fc receptors on macrophages; corticosteroids suppress antibody production over days to weeks. ## High-Yield Facts: - **Platelet transfusion alone is ineffective** in ITP because transfused platelets are rapidly destroyed by the same immune mechanism. - Splenectomy is considered **after confirming steroid response** (typically 2–4 weeks), not as an immediate intervention. - Bone marrow examination rules out aplasia and lymphoproliferative disorders but is not needed for diagnosis if clinical picture is clear. ## Clinical Pearl: In **acute ITP with severe thrombocytopenia and bleeding**, the goal is rapid platelet count recovery. IVIG provides faster hemostasis than steroids alone and is preferred in symptomatic patients.

Answer

A. Transfuse platelets and observe for spontaneous recovery

Answer

B. Initiate splenectomy after confirming steroid response

Answer

D. Perform flow cytometry to exclude lymphoproliferative disorder

A 35-year-old woman presents with spontaneous bruising, epistaxis, and a positive tourniquet test. Platelet count is 8,000/μL. Coagulation studies (PT, aPTT, fibrinogen) are normal. Bone marrow shows adequate megakaryocytes. What is the most appropriate immediate next step in management?

Explanation

Clinical Diagnosis

Management Algorithm for Acute ITP

Key Point:

High-Yield Facts:

Clinical Pearl:

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A 35-year-old woman presents with spontaneous bruising, epistaxis, and a positive tourniquet test. Platelet count is 8,000/μL. Coagulation studies (PT, aPTT, fibrinogen) are normal. Bone marrow shows adequate megakaryocytes. What is the most appropriate immediate next step in management?

Explanation

Clinical Diagnosis

Management Algorithm for Acute ITP

Key Point:

High-Yield Facts:

Clinical Pearl:

Practice similar questions

Join our NEET PG community