A 12-year-old girl presents with bleeding gums while brushing her teeth which started 1 week ago after a viral upper respiratory tract infection. On physical examination, the only... A 12-year-old girl presents with bleeding gums while brushing her teeth which started 1 week ago after a viral upper respiratory tract infection. On physical examination, the only findings are petechiae on her extremities and abdomen. There is no lymphadenopathy, or hepatosplenomegaly. Test results are as follows: Hb 130 (112-165 g/L), HCT 0.39 (0.32-0.42), MCV 88 (80-95 f1), WBC 8 (4.5-10.5 x 109/L), Platelets count 20 (150-400 x 109/L). Bone Marrow: Increased megakaryocytes. Which of the following is the most appropriate management? A. Azathioprine B. Prednisolone C. Splenectomy D. Cyclophosphamide Read more

Understand the Problem

The question describes a clinical scenario of a 12-year-old girl with bleeding gums and petechiae, her platelet count is low (20 x 10^9/L) despite normal values for other blood measures such as WBC and Hb, and lastly the bone marrow biopsy showed increased megakaryocytes. Based on this information, we must determine the most appropriate management option for this patient.

More Information

The patient's presentation (bleeding gums, petechiae, low platelet count with increased megakaryocytes in the bone marrow after a viral infection) is highly suggestive of Immune Thrombocytopenic Purpura (ITP). First-line treatment for ITP often involves corticosteroids like prednisolone.

Tips

A common mistake is to jump to more invasive treatments like splenectomy without trying less invasive options first, especially in a new-onset case of ITP.

Sources

• Overview of Platelet Disorders - Medscape Reference - emedicine.medscape.com