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Immune thrombocytopenia with bleeding — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesImmune thrombocytopenia with bleedingSCE Acute Medicine

A 35-year-old woman is assessed on the acute medical unit. She has mucosal bleeding and platelets 6 x10^9/L after viral illness. Coagulation screen and blood film are otherwise unremarkable. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: A — Give corticosteroid therapy and discuss IV immunoglobulin

Give corticosteroid therapy and discuss IV immunoglobulin is the best answer because severe thrombocytopenia with mucosal bleeding in ITP needs active treatment and haematology input. Give intramuscular adrenaline 500 micrograms is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Platelet transfusion is reserved for life-threatening bleeding or procedures.

Reference: BSH ITP guideline