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ITP Observation — RACP Paediatrics MCQ

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ModerateHaematology & OncologyITP ObservationRACP Paediatrics

A 9-year-old presents with petechiae and bruising. FBC shows isolated thrombocytopenia (platelets 25 x 10^9/L) with normal Hb and WCC. Blood film shows large platelets and no abnormal cells. He had a viral illness 2 weeks ago. The most likely diagnosis is ITP. What is the initial management if he has only dry purpura (skin bleeding only)?

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Correct answer: D — Observation (watch and wait)

Newly diagnosed ITP with only dry purpura (skin bleeding without mucosal bleeding) can be managed with observation alone regardless of platelet count. Pharmacological treatment (prednisolone or IVIG) is reserved for significant mucosal bleeding (wet purpura) or active bleeding. Most children with acute ITP recover spontaneously within 6 months.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: ITP