A 56-year-old woman is admitted to the hospital for induction chemotherapy after being diagnosed with acute myeloid leukemia. On hospital day 10, she develops scattered petechiae on her lower extremities but does not have epistaxis, hematuria, hematochezia, or other active bleeding. Her temperature is 37.1°C (98.8°F), blood pressure is 122/74 mm Hg, and pulse is 82/min. Laboratory studies show the following:
Hemoglobin: 8.4 g/dL
White blood cell count: 1,200/mm³
Platelet count: 8,000/mm³
The patient is otherwise stable and is not scheduled for any invasive procedures.
Which of the following is the most appropriate next step in management?
The correct answer is:
E) Transfuse platelets
Platelet transfusion is indicated for patients with severe thrombocytopenia to reduce the risk of spontaneous bleeding. In stable patients without active bleeding, prophylactic platelet transfusion is generally recommended when the platelet count falls below 10,000/mm³. This patient has a platelet count of 8,000/mm³ and evidence of petechiae, making platelet transfusion the most appropriate intervention.
Answer choice A: Administer desmopressin, is incorrect. Desmopressin is used to improve platelet function in conditions such as uremic platelet dysfunction, mild hemophilia A, and some cases of von Willebrand disease. It does not correct severe thrombocytopenia.
Answer choice B: Observe and repeat the platelet count in 24 hours, is incorrect. Observation alone is inappropriate because the platelet count is below the prophylactic transfusion threshold of 10,000/mm³, placing the patient at increased risk for spontaneous bleeding, including intracranial hemorrhage.
Answer choice C: Start intravenous methylprednisolone, is incorrect. Corticosteroids are often used in immune thrombocytopenia (ITP). This patient's thrombocytopenia is most likely due to chemotherapy-induced bone marrow suppression and requires platelet transfusion.
Answer choice D: Transfuse fresh frozen plasma, is incorrect. Fresh frozen plasma is used to replace clotting factors in patients with coagulopathy. It does not significantly increase the platelet count.
Key Learning Point
Platelet transfusion is generally indicated in stable, nonbleeding patients when the platelet count is less than 10,000/mm³ to prevent spontaneous hemorrhage. Higher transfusion thresholds may be used in patients with active bleeding or before invasive procedures.
