Question of the week # 283

283) A 26 year old man is seen in the office during a pre-employment health check-up. He has no medical problems. He denies smoking , alcohol or drug abuse. Physical examination  is benign. Laboratory investigations reveal:

WBC 8.8k/µl

Hemoglobin 15 g/dL,

Mean cell volume (MCV)  84  fL

Platelet count 45k/µl

Liver function tests, Electrolytes, Creatinine, Prothrombin time and Partial thromboplastin time are within normal limits. A peripheral blood smear shows reduced number of platelets with out any schistocytes or blasts or nucleated red cells. Antinuclear antibodies, HIV testing and Hepatitis C are negative.Upon further questioning, he denies any easy bruising, nose bleeds or gross bleeding. There is no family history of thrombocytopenia or bleeding disorder.

Which of the following is the most appropriate next step in managing this patient?

A) Intavenous Immunoglobulin

B) Prednisone

C) Observation

D) Bone marrow biopsy

E) Platelet transfusion

4 Responses

  1. C

  2. bbb

  3. ANS) (C) Platelet count > 30 —– OBSERVE….
    Platelet count < 30 —– STEROID….
    < 30 & no response to steroid in acute setting, or pt. needs surgery —– GIVE IVIG
    < 30 for 3 months with steroid OR < 10 for 4-6wks with steroid ——SPLENECTOMY

    <15 OR < 50 with Intracranial hemorrhage/or life threatening bleeding —————- PLATELET TRANSFUSION

  4. Answer C)
    Master the board
    Platelet count > 50,000 – no treatment
    count <50,000 with minor bleeding – prednisone
    count <20,000 with serious bleeding – IVIG or Rhogam
    Recurrent episodes – splenectomy
    No response to splenectomy – Romiplostim, eltrombopag

    This patient has Plt count 45,000 (<50,000) but no bleeding – observation

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