How should this patient's thrombocytopenia be managed?
A 39-year-old male with no known past medical history presents to clinic with complaints of 2 months of progressing fatigue and shortness of breath. On review of systems, he reports occasional gingival bleeding. Physical examination shows a pale conjunctiva and mild tachycardia. A complete blood count shows a white blood cell count of 0.2 (103/ L), a hemoglobin of 6 g/dL, and a platelet count of 18,000/ L. Serologies for hepatitis, mononucleosis, parvovirus, and HIV are negative. Bone marrow biopsy is performed, and a diagnosis of aplastic anemia is made.
A. Transfuse platelets to count of 30,000/ÂµL or greater B. Start recombinant granulocyte colony-stimulating factor C. Observe patient for signs of bleeding and transfuse platelets as needed D. Give hydroxyurea 1 g daily
Observe patient for signs of bleeding and transfuse platelets as needed-thrombocytopenia is a major problem associated with aplastic anemia. it should be managed by platelet transfusion as needed to control or prevent bleeding. usually, a threshold of 10,000 platelets/µl is used for transfusion, but conservative treatment is best, and as few transfusions as possible are given. extensive platelet replacement may result in allosensitization to platelets and may complicate future allogeneic bone marrow transplantation. granulocyte colony-stimulating factor is given to patients to raise the absolute neutrophil count and help combat infection. it has no effect on platelet levels. hydroxyurea is used in patients with essential thrombocytosis.