A 4-year-old girl has a 3-day history of petechiae over the legs following a viral upper respiratory infection 2 weeks ago. She has no mucosal bleeding, no organomegaly, and no lymphadenopathy. Hemoglobin and WBC counts are normal. Platelet count is 16,000/mm3. Peripheral smear shows large platelets and no blasts. What is the most appropriate next step?
- A Admit for IVIG infusion
- B Observation with no drug therapy ✓
- C Start oral prednisolone
- D Urgent bone marrow examination
Correct answer: B. Observation with no drug therapy
Explanation
Childhood immune thrombocytopenia is usually self-limiting after viral illness, and standard teaching (Nelson, ASH guidelines) is that therapy is directed at clinically significant bleeding, not the platelet number. An asymptomatic child with wet purpura absent can simply be observed regardless of how low the count is. IVIG and steroids are reserved for significant mucosal bleeding or when a rapid rise is needed. Bone marrow is unnecessary because the blood film shows isolated thrombocytopenia with no blasts.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.