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Immune thrombocytopenia — MRCPCH FOP MCQ

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HardHaematology and oncologyImmune thrombocytopeniaMRCPCH FOP

A 5-year-old girl has sudden bruising and petechiae two weeks after a viral illness. She is well, has no hepatosplenomegaly and blood tests show platelets 12 x 10^9/L with normal Hb and neutrophils. What is the most likely diagnosis?

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Correct answer: D — Immune thrombocytopenia

Isolated severe thrombocytopenia in a well child after a viral illness is most consistent with immune thrombocytopenia. Leukaemia is less likely without anaemia, neutropenia, hepatosplenomegaly or bone pain, though safety-netting is needed. Haemophilia causes deep bleeding and haemarthroses rather than petechiae from low platelets. The pearl is that mucosal bleeding and platelet count guide urgency.

Reference: BSH guideline immune thrombocytopenia; NICE CKS Bruising