A 30-year-old woman presents to her primary care provider with complaints of bleeding gums while brushing her teeth as well as menorrhagia and several episodes of epistaxis within the past month. She has been previously healthy with no prior medical problems or surgeries. Examination reveals petechiae and ecchymosis over the lower extremities. Laboratory results show white blood cell (WBC) count 7000/mm3, HGB 14 g/dL, hematocrit (HCT) 42%, and platelet count 28,000/mm3 with numerous megakaryocytes on peripheral smear. First-line therapy for this condition would be:
A. Oral prednisoneIdiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a low platelet count and mucocutaneous and petechial bleeding. The usual first line of therapy for ITP is oral prednisone with most responses occurring within the first 3 weeks after initiating therapy. Intravenous (IV) immunoglobulin is given for internal bleeding with platelet counts <5000/mm3, when extensive purpura exists, or to increase platelets preoperatively and is thought to work by impairing clearance of immunoglobulin G-coated platelets by competing for binding to tissue macrophage receptors. Both rituximab and thrombopoietin-receptor antagonists are second-line treatment options. Splenectomy is an option for refractory ITP and can provide a permanent response in about 75 to 85% of patients.