A 4-year-old boy presents with petechiae over both legs for 3 days, one week after a viral upper respiratory infection. There is no hepatosplenomegaly and no lymphadenopathy. Platelet count is 14,000/mm3. Hemoglobin, WBC count, and peripheral smear are otherwise normal.

• A Oral prednisolone ✓
• B Bone marrow aspiration before starting any therapy
• C Platelet transfusion to raise counts above 50,000/mm3
• D Intravenous immunoglobulin as first-line therapy

Explanation

The picture is typical immune thrombocytopenic purpura: isolated thrombocytopenia after a viral illness, otherwise well child, normal smear, no organomegaly. Standard first-line treatment is corticosteroids such as oral prednisolone. IVIG produces a faster rise and is reserved for serious bleeding or urgent needs. Bone marrow is required only if atypical features suggest leukemia. Platelet transfusions are ineffective because autoantibodies destroy transfused platelets and are used only for life-threatening hemorrhage.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.