## 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.
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