A 4-year-old boy presents with petechiae over the legs and epistaxis for 3 days, 2 weeks after a viral upper respiratory infection. He is otherwise well, with no hepatosplenomegaly or lymphadenopathy. Platelet count is 14 × 10^9/L; hemoglobin and WBC are normal. Peripheral smear shows large platelets and no blasts. What is the most appropriate initial management?

• A Bone marrow examination before starting any therapy
• B Platelet transfusion to raise the count above 50 × 10^9/L
• C Oral prednisolone at 1 to 2 mg/kg/day ✓
• D Splenectomy as first-line therapy

Explanation

The picture of isolated thrombocytopenia after a viral illness in a well child with normal smear and no organomegaly is classic immune thrombocytopenia. First-line therapy when bleeding is significant is corticosteroids such as oral prednisolone; IVIG is an alternative when rapid rise is needed. Bone marrow is reserved for atypical features, and splenectomy is second-line. Platelet transfusion is ineffective because autoantibodies destroy transfused platelets and is used only for life-threatening hemorrhage.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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