Which of the following is the most appropriate management for a 12-year-old girl presenting with bleeding gums and petechiae after a viral infection, with a platelet count of 20 x... Which of the following is the most appropriate management for a 12-year-old girl presenting with bleeding gums and petechiae after a viral infection, with a platelet count of 20 x 10^9/L and increased megakaryocytes on bone marrow examination?
Understand the Problem
The question describes a clinical scenario of a 12-year-old girl presenting with bleeding gums and petechiae after a viral infection. Lab results show significantly decreased platelet count (thrombocytopenia) with normal Hb, HCT, MCV, and WBC. Bone marrow examination reveals increased megakaryocytes. The question asks to determine the most appropriate management option among the given choices (Azathioprine, Prednisolone, Splenectomy, and Cyclophosphamide). This suggests we need to recognize the most likely diagnosis based on the clinical presentation and lab findings, and then select the treatment that aligns with the standard management of that condition.
Answer
Supportive care, possible steroids or IVIG, and close monitoring.
Based on the search results, the most appropriate immediate management would likely involve supportive care and possibly a course of steroids (dexamethasone or prednisone) or IVIG, especially if bleeding is significant. Close monitoring of the platelet count is essential.
Answer for screen readers
Based on the search results, the most appropriate immediate management would likely involve supportive care and possibly a course of steroids (dexamethasone or prednisone) or IVIG, especially if bleeding is significant. Close monitoring of the platelet count is essential.
More Information
The patient's presentation suggests Immune Thrombocytopenia (ITP), triggered by a recent viral infection. A platelet count of 20 x 10^9/L is considered low and increases bleeding risk. Increased megakaryocytes in the bone marrow confirm that the bone marrow is trying to compensate for the low platelet count. Tranexamic acid may be used as well.
Tips
Treatment depends on the severity of bleeding and the platelet count. The goal of treatment is to prevent significant bleeding complications while minimizing treatment-related side effects.
Sources
- Immune Thrombocytopenia - StatPearls - NCBI Bookshelf - ncbi.nlm.nih.gov
- Identifying and treating refractory ITP: difficulty in diagnosis and role ... - ashpublications.org
- Overview of Platelet Disorders - Medscape Reference - emedicine.medscape.com
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