Board Review: Internal Medicine
A 5 year old boy presents to the ED with epistaxis in the setting of a recent respiratory illness. On exam you note a diffuse petechial rash with scattered bruises and the child appears mildly fatigued. Her vital signs are normal. Her blood work reveals a normal WBC and Hgb however platelets are 9,000. What is the best treatment for this patient at this time?
A. Platelet transfusion
B. Do not treat at this time
D. Steroids and IVIG or anti-D immunoglobulin
Answer: D. This is a case of Idiopathic Thrombocytopenic Purpura, or ITP. This is a condition most common in children aged 2-5 years caused by autoantibodies against the platelet membrane antigen ultimately resulting in thrombocytopenia. These patients will often have a history of a viral illness within the past month. Treatment depends on severity of bleeding and platelet count, and in mild asymptomatic cases, sometimes just watchful waiting is appropriate as many recover without intervention. However, for this patient with platelets <10,000 and bleeding, steroids and IVIG/anti-D Ig are warranted.
Imbach, Paul. (2020). Clinical Research of Idiopathic Thrombocytopenic Purpura ITP by the Intercontinental Childhood ITP Study Group ICIS.