A patient presents to the emergency department complaining of intractable epistaxis. Upon assessment, the nurse notes petechiae and ecchymosis covering the patient’s chest and arms. The patient is otherwise well. Laboratory results are normal with exception of the patient’s platelet count, which is abnormally low (29,000/microL). The nurse anticipates an order for which medication?

Question

A patient presents to the emergency department complaining of intractable epistaxis. Upon assessment, the nurse notes petechiae and ecchymosis covering the patient&rsquo;s chest and arms. The patient is otherwise well. Laboratory results are normal with exception of the patient&rsquo;s platelet count, which is abnormally low (29,000/microL). The nurse anticipates an order for which medication?

Accepted Answer

IV methylprednisolone. The otherwise healthy patient with intractable bleeding, widespread bruising, petechiae, and low platelets who does not have any other laboratory abnormalities likely has immune thrombocytopenic purpura (ITP). The drug of choice for ITP is a corticosteroid such as IV methylprednisolone, which can help stop bleeding and help normalize platelet counts. IV Immunoglobulin (IVIG) is the second-line drug. IVIG is sometimes administered together with methylprednisolone for severe bleeding, which this patient does not have. IM phytonadione is used to treat warfarin overdose and is administered to neonates to prevent hemorrhage. Epoetin is used to treat anemia, not ITP. The patient may also receive a platelet transfusion.

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