Question

A previously healthy six-year-old girl is brought to the emergency room by her parents because of sudden bruising. She noted bruising when she woke up this morning. She denies trauma, fever, joint pain, weight loss, headache, nose bleeding, or blood in the stool. She did not have any prior illness. On physical examination, vital signs are normal, with petechiae and purpura on the extremities, chest, and buttocks. Laboratory testing shows platelet count of 30,000/microL. Which of the following is the next best step in management?

A) Infuse intravenous immunoglobulin (IVIG)
B) Platelet transfusion
C) Restrict physical activities with risk of trauma
D) Start glucocorticoids

Answer 1

The best management step for a previously healthy six-year-old girl with sudden bruising, petechiae, purpura, and a low platelet count is likely starting treatment with glucocorticoids and restricting physical activities to reduce the risk of bleeding.

Step-by-step explanation:

A previously healthy six-year-old girl is brought to the emergency room by her parents because of sudden bruising. On physical examination, vital signs are normal, but there are petechiae and purpura on the extremities, chest, and buttocks. Her platelet count is notably low at 30,000/microL, suggesting a potential acute platelet disorder. The presence of petechiae, purpura, and a low platelet count raises suspicion for a condition such as idiopathic thrombocytopenic purpura (ITP), which is often treated with glucocorticoids or intravenous immunoglobulin (IVIG) to raise the platelet count. A platelet transfusion is typically not the first-line treatment in the absence of severe bleeding or very low platelet counts, and in this case, the platelet count is not critically low, nor is there an indication of significant bleeding. Therefore, the next best step in management for this patient would most likely be to start treatment with glucocorticoids to help increase platelet production and decrease destruction. Additionally, restricting physical activities with risk of trauma is prudent to minimize the risk of bleeding.