11-20-2006, 04:45 PM
An 8-year-old girl is brought by her father to your office because of "blood blisters" in the child's mouth and a rash on her lower legs that began 24 hours ago. She has no complaints and has no focal numbness or weakness. The child has always been healthy, although she did have a high fever, rash, muscle aches, and headache for a 4-day period 1 month ago. She did not see a physician for that illness, and recovered completely with oral fluids and Tylenol for her fever. She takes no medications since last receiving antibiotics 3 years ago for strep throat. Her three close-in-age siblings are without any of her current, or other, symptoms. There is no family history of bleeding disorders. On exam, the child is in no acute distress and is alert and oriented x 3.
Her vital signs are normal. Retinas are normal by funduscopic exam. Extraocular movements (EOMs) are intact; speech and gait are normal. Several hemorrhagic bullae are present on the buccal mucosa. There is no gingival bleeding. Nonpalpable petechiae are present on the lower extremities. There are no other abnormal findings. You order a complete blood count (CBC), which shows Hgb 14.5 gm/dL, Hct 40%, RBC 450K, WBC 6k, Plt 18K, neutrophils 60, segs 54, bands 3%, lymphocytes 27%, monocytes 4%, eosinophils 1%, basophils 0%.
The patient™s peripheral smear shows isolated thrombocytopenia only, with no abnormal RBC or platelet morphology. The patient™s clinical status is unchanged. What is the next step in treatment of the patient™s condition?
A. High-dose IV glucocorticoids
B. IVIg infusion
C. Plasmapheresis
D. Platelet transfusion
E. Splenectomy
Her vital signs are normal. Retinas are normal by funduscopic exam. Extraocular movements (EOMs) are intact; speech and gait are normal. Several hemorrhagic bullae are present on the buccal mucosa. There is no gingival bleeding. Nonpalpable petechiae are present on the lower extremities. There are no other abnormal findings. You order a complete blood count (CBC), which shows Hgb 14.5 gm/dL, Hct 40%, RBC 450K, WBC 6k, Plt 18K, neutrophils 60, segs 54, bands 3%, lymphocytes 27%, monocytes 4%, eosinophils 1%, basophils 0%.
The patient™s peripheral smear shows isolated thrombocytopenia only, with no abnormal RBC or platelet morphology. The patient™s clinical status is unchanged. What is the next step in treatment of the patient™s condition?
A. High-dose IV glucocorticoids
B. IVIg infusion
C. Plasmapheresis
D. Platelet transfusion
E. Splenectomy