A 4-Year-Old Boy Is Brought to the Office for Evaluation

A 4-year-old boy is brought to the office for evaluation of a rash.  His mother states that "pinpoint" bruises have appeared all over his body during the past 24 hours.  The patient has had no bleeding or recent trauma.  Three weeks ago, he had an upper respiratory tract infection that resolved uneventfully.  The patient takes no medications, he has no allergies, and his immunizations are up to date.  There is no family history of bleeding or clotting disorders.  Vital signs are normal for age.  Physical examination shows a cooperative, well-appearing child with scattered petechiae on the trunk and extremities.  Oral mucosa appears normal.  There is no lymphadenopathy or splenomegaly.  Laboratory results are as follows: Peripheral smear shows few platelets; the platelets are of normal size and morphology.  Which of the following is the best next step in management of this patient?

A) Bone marrow evaluation
B) Intravenous antibiotics
C) Intravenous immunoglobulin
D) Observation
E) Platelet transfusion
F) Splenectomy

Correct Answer:

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