Part 2: Immune Thrombocytopenia

Thomas G. DeLoughery, MD, FACP

Professor of Medicine, Pathology, and Pediatrics, Division of Hematology/Medical Oncology, Knight Cancer Center, Departments of Medicine and Pediatrics, and Division of Laboratory Medicine, Department of Pathology, Oregon Health Sciences University, Portland, OR

Question 1

A 4-year-old girl presents with her parents for evaluation after she developed a large bruise after playing soccer. A complete blood count is performed and reveals a platelet count of 11 x 103/L. Except for a viral syndrome a couple of weeks ago, she is otherwise healthy. She is not taking any medications and there is no family history of bleeding diathesis. Physical exam reveals a healthy young child with no lymphadenopathy, splenectomy, or oral purpura. What is the optimal initial management option for this patient?

  •  Prednisone 1 mg/kg daily until the platelet count is over 50 x 103/L
  •  A single 1 g/kg dose of intravenous immune globulin (IVIG)
  •  A single 75 g/kg dose of IV anti-D immune globulin
  •  Rituximab 375 mg/m2 weekly for 4 weeks
  •  Observation for bleeding

Updated 6/01/2011 • jdw | Copyright ©2014 Turner White Communications