A 24-year-old woman presents with petechiae over the legs and gum bleeding. Platelet count is 14,000 per microliter. Hemoglobin, white cell count, peripheral smear, and coagulation profile are otherwise normal. Bone marrow shows increased megakaryocytes. What is the most appropriate first-line treatment?

• A Platelet transfusion
• B Oral prednisolone ✓
• C Splenectomy
• D Intravenous immunoglobulin as definitive therapy

Explanation

Newly diagnosed immune thrombocytopenic purpura with significant mucosal bleeding is treated first with corticosteroids, which reduce antibody-mediated destruction by splenic macrophages and improve platelet production. IVIG produces a faster but transient rise and is reserved for emergencies such as active serious bleeding or pre-surgery. Splenectomy is second-line for chronic refractory disease. Platelet transfusion is ineffective because autoantibodies destroy transfused platelets within hours, so it is used only for life-threatening hemorrhage.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.