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Immune Thrombocytopaenia — RACP Adult Medicine MCQ

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EasyHaematologyImmune ThrombocytopaeniaRACP Adult Medicine

A 25-year-old woman presents with menorrhagia and easy bruising. Her platelet count is 15 × 10⁹/L. Blood film confirms isolated thrombocytopaenia with no abnormal cells. What is the most appropriate initial treatment?

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Correct answer: A — Prednisolone 1 mg/kg/day

This presentation is consistent with immune thrombocytopaenic purpura (ITP). First-line treatment is prednisolone 1 mg/kg/day for 2–4 weeks with subsequent taper. IVIg can be added if a rapid rise in platelets is needed (e.g. life-threatening bleeding or urgent surgery). Platelet transfusion is generally ineffective due to rapid platelet destruction but may be given alongside IVIg in life-threatening haemorrhage. TPO receptor agonists (romiplostim, eltrombopag) are second-line.

Reference: eTG – 2025 – Haematology; ASH – 2019 – ITP Guidelines