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
Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer hematology, Hematology, internal medicine board review, USMLE step 3 Hematology |
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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
Answer C)
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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
c