A healthy 3-year-old girl develops petechiae over both legs 10 days after a febrile upper respiratory illness. She has no hepatosplenomegaly and no lymphadenopathy. Hemoglobin and WBC counts are normal. Platelet count is 16,000/mm3, and the peripheral smear shows only thrombocytopenia with large platelets. There is no active mucosal bleeding. What is the most appropriate next step?
- A Bone marrow examination
- B Platelet transfusion
- C Observation without specific therapy ✓
- D Splenectomy
Correct answer: C. Observation without specific therapy
Explanation
This is classic immune thrombocytopenia (ITP): a well child, isolated severe thrombocytopenia after a viral illness, normal smear apart from large platelets, and no organomegaly. Current practice, followed in Indian exam keys, is observation when there is no significant bleeding, regardless of how low the count is. Bone marrow is needed only if atypical features appear. Platelets are transfused only for life-threatening hemorrhage because transfused platelets are rapidly destroyed by autoantibodies.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.