Bruising and Petechiae

🗒️ Question

A 38 year old woman presents with a 1 week history of easy bruising, petechial rash on her arms and legs and bleeding gums. She denies recent infections, medication changes or any significant past medical history

On examination, she appears clinically well and afebrile. There are widespread petechiae and several large ecchymoses on her lower limbs. There is no hepatosplenomegaly or lymphadenopathy.

Investigations

• Haemoglobin: 135 g/L (115–150)

• White cell count: 6.2 × 10⁹/L (4.0–11.0)

• Platelets: 8 × 10⁹/L (150–450)

• Peripheral blood film: Normal morphology

• Coagulation profile: Normal

What is the most appropriate initial management?

(A) Intravenous immunoglobulin

(B) Observation without treatment

(C) Oral corticosteroids

(D) Platelet transfusion

(E) Rituximab