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Severe immune thrombocytopenia with bleeding — SCE Acute Medicine MCQ

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EasyHaematological EmergenciesSevere immune thrombocytopenia with bleedingSCE Acute Medicine

A 55-year-old man presents with fever, bleeding, thrombosis or severe anaemia. Relevant history includes malignancy, chemotherapy, haemoglobinopathy or anticoagulant exposure. On assessment, blood film and coagulation results are abnormal. Investigations show platelets 4 with mucosal bleeding and normal coagulation. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Give high-dose corticosteroid with intravenous immunoglobulin for significant bleeding

The key discriminator is that platelets 4 with mucosal bleeding and normal coagulation, which makes Give high-dose corticosteroid with intravenous immunoglobulin for significant bleeding the single best answer. Optimise chronic medication and discharge is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent CT imaging would fit a different presentation or later stage of care. Provide supportive care and close monitoring and Arrange routine outpatient follow-up are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSH ITP guidance