Question

A 3 year old male is brought to the physician by his mother after she noted multiple bruises on his body. She denies any recent trauma. Two weeks ago, the patient had three days of cough and low-grade fever that resolved without antibiotic therapy, but since that time he has been well. Past medical history is otherwise unremarkable. The patient is up-to-date on all required immunizations. On physical exam, the patient is afebrile and playing happily at his mother's feet in the examination room. There are no peritonsillar exudates. Tympanic membranes are clear. There is no abdominal tenderness or organomegaly. Examination of the skin shows diffuse and numerous petechiae and purpura. Laboratory analysis reveals the following: WBC 7.5 k/mcL; hemoglobin 12 g/dL; hematocrit 36%; platelets 27 k/mcL; total bilirubin 0.7 mg/dL; AST 22 U/L; ALT 18 U/L; alkaline phosphatase 120 U/L; LDH 186 U/L; PT 11 s (normal 11-13s); PTT 22 s (normal 20-30s). Which of the following is the most appropriate initial treatment for this patient's disorder?

120 U/L; LDH 186 U/L; PT 11 s (normal 11-13s); PTT 22 s (normal 20-30s). Which of the following is the most appropriate initial treatment for this patient's disorder?
A. Prednisone
B. Ceftriaxone
C. Vincristine
D. Cyclophosphamide
E. Immediate platelet transfusion

Answer 1

The most appropriate initial treatment for the 3-year-old patient with thrombocytopenia and suspected immune thrombocytopenic purpura (ITP) is Prednisone, a corticosteroid, because it helps in increasing platelet counts by modulating the immune response.

Step-by-step explanation:

The clinical scenario presented, showing a 3-year-old male with multiple bruises, diffuse petechiae, and purpura, and a significantly reduced platelet count of 27 k/mcL, suggests a condition of thrombocytopenia which might be consistent with immune thrombocytopenic purpura (ITP). ITP is an autoimmune disorder characterized by the immune system mistakenly attacking and destroying platelets. Given the patient's current stable condition without active bleeding, the most appropriate initial treatment is Prednisone, a corticosteroid used to dampen the immune response and increase platelet count. Treatments such as Immediate platelet transfusion may be reserved for cases of severe bleeding or before surgical procedures where the bleeding risk is high. This patient does not exhibit signs that warrant aggressive interventions like chemotherapy agents, which are represented by Ceftriaxone, Vincristine, and Cyclophosphamide, and therefore, these are not the correct initial treatments in this case.