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A 2 3-year-old female patien t presen ts wi th com plai n ts of "spots on my legs ." She has been in her normal state of health recen tly with the exception of cold symptoms that las ted for 5 days and have now resolved . Complete blood count shows hemoglobin of 1 LJ.5g/dl. leukocyte count of 8.900/,LLL. and platelet count of 1 3 ,000/,LLL. Photographs of the patient and her peripheral blood smear are shown below.
The patient has hemoglobin level of 14.5 g/dL, platelet count of 13,000/,LLL, and leukocyte count of 8,900/ ,LLL. Which of the treatments below is a reasonable first treatment option in the absence of bleeding symptoms?
- Plasma exchange
- Splenectomy
- Cyclophosphamide
- Prednisone
- Rituximab
Medicine
D. In patients diagnosed with immune thrombocytopenia, prednisone 1 mg/kg daily is a reasonable choice for first-line therapy in the absence of bleeding symptoms. Plasma exchange does not have a role in treatment of ITP, unlike its primary role in the treatment of TTP. Splenectomy, chemotherapy, and rituximab are all second-line therapies reserved for patients unresponsive to ste-roid therapy.
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