Haematology: immune thrombocytopenia in adults: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Haematology: immune thrombocytopenia in adults

Sample item

A 30-year-old woman has easy bruising, gum bleeding and petechiae. Platelets are 12,000 per microlitre with a normal haemoglobin and white cell count, giant platelets on the film, no splenomegaly and no drug exposure. What is the first-line therapy?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Oral glucocorticoid such as prednisolone or dexamethasone

Isolated thrombocytopenia with large platelets, a normal examination and no cause is primary immune thrombocytopenia, in which antiplatelet antibodies cause splenic destruction and impaired production. Corticosteroids are the first-line treatment for adults with significant bleeding or counts below about 30,000, and IVIG is added for severe bleeding. Platelet transfusion is reserved for life-threatening bleeding.

Option by option

  • A. Oral glucocorticoid such as prednisolone or dexamethasone (correct)

    Correct. Steroids reduce antibody-mediated platelet destruction and raise the count in most patients.

  • B. Plasma exchange

    Plasma exchange is for thrombotic thrombocytopenic purpura, which has anaemia and schistocytes.

  • C. Emergency splenectomy

    Splenectomy is an option only after failure of medical therapy.

  • D. Daily prophylactic platelet transfusions

    Transfused platelets are destroyed rapidly and are used only for life-threatening bleeding.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Oral glucocorticoid such as prednisolone or dexamethasone. Isolated thrombocytopenia with large platelets, a normal examination and no cause is primary immune thrombocytopenia, in which antiplatelet antibodies cause splenic destruction and impaired production.

Why is "Plasma exchange" not the answer?

Plasma exchange is for thrombotic thrombocytopenic purpura, which has anaemia and schistocytes.

Why is "Emergency splenectomy" not the answer?

Splenectomy is an option only after failure of medical therapy.

Why is "Daily prophylactic platelet transfusions" not the answer?

Transfused platelets are destroyed rapidly and are used only for life-threatening bleeding.

What concept does this question test?

It tests Haematology: immune thrombocytopenia in adults in General Medicine. Corticosteroids are the first-line treatment for adults with significant bleeding or counts below about 30,000, and IVIG is added for severe bleeding. Platelet transfusion is reserved for life-threatening bleeding.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: immune thrombocytopenia in adults?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.