A 12-year-old girl presents with bleeding gums while brushing her teeth, starting 1 week ago after a viral upper respiratory tract infection. Physical examination shows petechiae o... A 12-year-old girl presents with bleeding gums while brushing her teeth, starting 1 week ago after a viral upper respiratory tract infection. Physical examination shows petechiae on extremities and abdomen. No lymphadenopathy or hepatosplenomegaly. Lab results: Hb 130 g/L, HCT 0.39, MCV 88 f1, WBC 8 x 109/L, Platelets 20 x 109/L. Bone Marrow: Increased megakaryocytes. Which is the most appropriate management: A. Azathioprine B. Prednisolone C. Splenectomy
Understand the Problem
The prompt describes a clinical case of a 12-year-old girl with bleeding gums and petechiae following a viral infection. Her platelet count is significantly low (20 x 10^9/L), while other blood parameters are within normal limits. Bone marrow examination reveals increased megakaryocytes. The question asks for the most appropriate management option. Given the symptoms and lab results, the patient likely has immune thrombocytopenic purpura (ITP). The question requires the selection of the best initial treatment from the options provided.
Answer
Prednisolone.
The most appropriate management is Prednisolone. The patient likely has immune thrombocytopenic purpura (ITP), and corticosteroids are a first-line treatment.
Answer for screen readers
The most appropriate management is Prednisolone. The patient likely has immune thrombocytopenic purpura (ITP), and corticosteroids are a first-line treatment.
More Information
The patient's presentation (recent viral infection, petechiae, low platelet count with increased megakaryocytes in the bone marrow) is consistent with immune thrombocytopenic purpura (ITP). First line treatment includes corticosteroids.
Tips
A common mistake is to consider splenectomy too early in the management of ITP. Splenectomy is usually reserved for patients who do not respond to first-line treatments.
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