An 18-month-old boy presents with pallor, decreased urine output, and petechiae 4 days after an episode of bloody diarrhea. Hemoglobin is 6.5 g/dL, platelet count is 40,000/mm3, blood urea is 110 mg/dL, and peripheral smear shows fragmented red cells. Which intervention is contraindicated in this child?

• A Supportive fluid and electrolyte management
• B Platelet transfusion in the absence of active bleeding ✓
• C Packed red cell transfusion for symptomatic anemia
• D Peritoneal dialysis if uremia or hyperkalemia progresses

Explanation

This is typical diarrhea-associated hemolytic uremic syndrome caused by Shiga toxin producing E. coli O157:H7. The triad is microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Platelet transfusion is avoided unless there is life threatening bleeding because transfused platelets fuel ongoing microvascular thrombosis. Careful packed cell transfusion, fluid management, and dialysis when indicated remain standard supportive care.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.