Thrombocytopenia — MCQs
Cause of ITP is
An 8-year-old boy presents with petechiae, azotemic oliguria and altered sensorium, in casualty. There is a history of diarrhoea for the past 5 days. The clinical diagnosis is –
Which of the following is not a characteristic of Fanconi's anemia?
A neonate presents with the condition shown in the image below. This condition has all of the following features EXCEPT:
A 5-year-old boy presents with petechial bleeding and bruising on his torso and limbs. He has no other signs or symptoms and does not appear ill. His mother reports a gastrointestinal infection several weeks prior to the onset of petechiae and bruising. Complete blood count reveals thrombocytopenia (<20 x 10^9/L), with other parameters within the expected range for his age. Prothrombin time, partial thromboplastin time, and metabolic panels are all within the reference range. What is the expected outcome of this blood disorder?
A 9-year-old girl develops widespread pinpoint skin hemorrhages after recovering from a flu-like illness 1 week earlier. Laboratory findings reveal a platelet count of 20,000/mL with no other abnormalities. Her bone marrow shows an increased number of megakaryocytes. The platelet count is normal after 2 months. Which of the following is the appropriate diagnosis?
A patient presents with ecchymoses and petechiae all over the body and no hepatosplenomegaly. Which of the following statements is NOT true?
In a newborn, Harlequin skin change is due to what underlying condition?
A 3-year-old child presented with progressive anemia, jaundice, and failure to thrive. On examination, pallor and splenomegaly are seen. Peripheral smear showed normoblasts and small round intensely stained red cells. What is the likely diagnosis?
What is the hemoglobin level indicative of anemia in a child aged 2 to 5 years?
Thrombocytopenia Indian Medical PG Practice Questions and MCQs
Question 1: Cause of ITP is
- A. Vasculitis
- B. Antibody to platelets (Correct Answer)
- C. Antibody to vascular epithelium
- D. Antibody to clotting factors
Explanation: The cause of ITP is: ***Antibody to platelets*** - **Immune thrombocytopenic purpura (ITP)** is an autoimmune disorder [1] characterized by the destruction of platelets due to the presence of **autoantibodies**, primarily targeting platelet surface glycoproteins like **GPIIb/IIIa**. - These antibodies lead to premature destruction or increased consumption [1] of platelets by the reticuloendothelial system, particularly in the spleen, resulting in **thrombocytopenia**. *Vasculitis* - **Vasculitis** is inflammation of the blood vessels, which can cause symptoms like purpura but typically does not primarily cause isolated severe thrombocytopenia as seen in ITP. - While it can lead to bleeding manifestations, the underlying mechanism is vascular inflammation, not direct platelet destruction by antibodies. *Antibody to vascular epithelium* - Antibodies to **vascular endothelium** are seen in conditions such as some forms of vasculitis or autoimmune disorders like lupus, but they directly target vessel walls, not platelets. - This typically leads to endothelial damage and inflammation, rather than isolated thrombocytopenia from platelet destruction. *Antibody to clotting factors* - Antibodies to **clotting factors** (e.g., Factor VIII inhibitors) cause **hemophilia-like bleeding disorders** by interfering with the coagulation cascade. - This mechanism results in impaired clot formation, not primarily in low platelet counts as is characteristic of ITP.
Question 2: An 8-year-old boy presents with petechiae, azotemic oliguria and altered sensorium, in casualty. There is a history of diarrhoea for the past 5 days. The clinical diagnosis is –
- A. H.U.S. (Correct Answer)
- B. H.S. purpura
- C. Idiopathic thrombocytopenic purpura
- D. Acute porphyria
Explanation: **H.U.S.** * The constellation of **petechiae** (indicating **thrombocytopenia**), **azotemic oliguria** (suggesting **acute kidney injury**), and **altered sensorium** (neurological involvement) following recent **diarrhea** is highly characteristic of **Hemolytic Uremic Syndrome (HUS)**, specifically **Shiga toxin-producing E. coli (STEC)-HUS**. * HUS is defined by the triad of **microangiopathic hemolytic anemia**, **thrombocytopenia**, and **acute kidney injury**, often precipitated by a gastrointestinal infection. *Acute prophyria* * **Acute porphyrias** are metabolic disorders affecting heme synthesis, presenting with acute neurovisceral attacks. * While they can cause neurological symptoms, they are not typically associated with **petechiae**, **thrombocytopenia**, or **renal failure** following diarrhea. *H.S. purpura* * **Henoch-Schönlein (IgA vasculitis) purpura** is characterized by palpable purpura, arthritis, abdominal pain, and renal involvement (hematuria/proteinuria). * While it can cause **purpuric rash** and **renal disease**, it typically presents with **palpable purpura** (due to vasculitis), not petechiae from thrombocytopenia, and is less commonly associated with severe oliguric acute kidney injury or profound altered mental status in this context. *Idiopathic thrombocytopenic purpura* * **Idiopathic Thrombocytopenic Purpura (ITP)** is characterized by **isolated thrombocytopenia** leading to bleeding manifestations like **petechiae** and purpura. * ITP does not typically cause **azotemic oliguria** or **altered sensorium**, as it primarily affects platelet count without involvement of other organ systems like the kidneys or central nervous system.
Question 3: Which of the following is not a characteristic of Fanconi's anemia?
- A. Skeletal anomalies
- B. Pancytopenia
- C. Chromosome fragility
- D. Bone marrow failure in infancy (Correct Answer)
Explanation: ***Bone marrow failure in infancy*** - Fanconi anemia patients are typically **asymptomatic at birth** with normal blood counts. - **Progressive bone marrow failure** develops gradually, with median age of onset around **7 years** (range 5-10 years). - While subtle hematologic changes (macrocytosis, elevated HbF) may appear earlier, clinically significant **pancytopenia does not occur in infancy**. - This delayed hematologic presentation distinguishes Fanconi anemia from other congenital bone marrow failure syndromes. *Pancytopenia* - **Pancytopenia** is the hallmark hematologic feature of Fanconi anemia, but develops in **mid-childhood**, not infancy. - Results from progressive bone marrow failure affecting all three cell lines: **red blood cells, white blood cells, and platelets**. - Thrombocytopenia is often the first manifestation, followed by anemia and neutropenia. *Skeletal anomalies* - **Skeletal anomalies** are common congenital malformations present in approximately **60-75%** of patients. - Include **radial ray defects** (absent or hypoplastic thumbs, absent radius), **short stature**, and other limb abnormalities. - These are present from birth and often lead to early clinical suspicion. *Chromosome fragility* - **Chromosome fragility** is the **diagnostic hallmark** of Fanconi anemia due to defective DNA repair mechanisms. - Diagnostic test uses **diepoxybutane (DEB)** or **mitomycin C (MMC)** to induce DNA crosslinks, revealing increased chromosomal breaks and rearrangements. - This test is positive regardless of age or hematologic status.
Question 4: A neonate presents with the condition shown in the image below. This condition has all of the following features EXCEPT:
- A. Ectropion
- B. Eclabium
- C. Hard elastic scales over the neck area
- D. Satellite lesions (Correct Answer)
Explanation: ***Satellite lesions*** - **Satellite lesions** (smaller lesions located near a main rash) are characteristic of certain fungal infections like candidiasis or some viral rashes, but not of **collodion baby/harlequin ichthyosis**, which is suggested by the image. - The image shows features consistent with a severe congenital ichthyosis, where **skin scaling** and **facial deformities** are prominent, not scattered papules or pustules. *Ectropion* - **Ectropion** (eversion of the eyelids) is clearly visible in the image, where the eyelids are pulled outwards, exposing the conjunctiva. - This is a common feature in conditions like **collodion baby** and **harlequin ichthyosis** due to the restrictive outer skin layer. *Eclabium* - **Eclabium** (eversion of the lips) is also distinctly present in the image, with the lips appearing stretched and everted. - This is another characteristic manifestation of severe congenital ichthyosis, resulting from the **tight, hardened skin** around the mouth. *Hard elastic scales over the neck area* - The image shows **thickened, furrowed, and scaly skin** texture, particularly noticeable around the neck area (indicated by the arrow), which aligns with the description of **hard, elastic scales**. - This is a hallmark feature of **ichthyosis**, where there is impaired skin barrier function and excessive scale production.
Question 5: A 5-year-old boy presents with petechial bleeding and bruising on his torso and limbs. He has no other signs or symptoms and does not appear ill. His mother reports a gastrointestinal infection several weeks prior to the onset of petechiae and bruising. Complete blood count reveals thrombocytopenia (<20 x 10^9/L), with other parameters within the expected range for his age. Prothrombin time, partial thromboplastin time, and metabolic panels are all within the reference range. What is the expected outcome of this blood disorder?
- A. Complete resolution is expected. (Correct Answer)
- B. Survival rate is up to 70% depending on risk stratification.
- C. Lifelong disease dependent on factor VIII substitution.
- D. Lifelong disease dependent on factor IX substitution.
Explanation: ### Explanation The clinical presentation describes a classic case of **Immune Thrombocytopenic Purpura (ITP)**, the most common cause of isolated thrombocytopenia in children. **1. Why Option A is Correct:** In children, ITP typically follows a viral infection (respiratory or gastrointestinal) after a 1–4 week latent period. It is characterized by the sudden onset of petechiae and bruising in an otherwise healthy-appearing child. The hallmark is **isolated thrombocytopenia** (Platelets <100 x 10⁹/L) with normal PT, PTT, and hemoglobin. The prognosis is excellent; approximately **70–80% of children achieve complete spontaneous resolution** within 6 months, regardless of therapy. **2. Why the Other Options are Incorrect:** * **Option B:** This refers to the survival rates of pediatric malignancies like Acute Lymphoblastic Leukemia (ALL). While ALL presents with bruising, it typically involves "sick" symptoms (fever, bone pain), hepatosplenomegaly, and abnormalities in other cell lines (anemia/leukocytosis). * **Options C & D:** These describe **Hemophilia A (Factor VIII)** and **Hemophilia B (Factor IX)**. Hemophilias are coagulation factor deficiencies that present with deep tissue bleeds (hemarthrosis/hematomas) and a **prolonged aPTT**, rather than petechiae and isolated thrombocytopenia. **3. NEET-PG High-Yield Pearls:** * **Pathophysiology:** Anti-platelet antibodies (IgG) directed against GP IIb/IIIa or GP Ib/IX. * **Bone Marrow:** Not routinely required but would show **increased megakaryocytes** (compensatory). * **Management:** Observation is preferred if bleeding is minimal (dry purpura). If treatment is needed (wet purpura/active bleeding), **IVIG** or **Corticosteroids** are first-line. * **Chronic ITP:** Defined as thrombocytopenia persisting >12 months (occurs in ~20% of cases).
Question 6: A 9-year-old girl develops widespread pinpoint skin hemorrhages after recovering from a flu-like illness 1 week earlier. Laboratory findings reveal a platelet count of 20,000/mL with no other abnormalities. Her bone marrow shows an increased number of megakaryocytes. The platelet count is normal after 2 months. Which of the following is the appropriate diagnosis?
- A. Antiphospholipid antibody syndrome
- B. Disseminated intravascular coagulation
- C. Hemolytic-uremic syndrome
- D. Idiopathic thrombocytopenic purpura (Correct Answer)
Explanation: ### Explanation **Correct Answer: D. Idiopathic thrombocytopenic purpura (ITP)** **Concept:** The clinical presentation is classic for **Acute Immune Thrombocytopenic Purpura (ITP)**. In children, ITP typically follows a viral prodrome (like the flu) by 1–3 weeks. It is caused by **Type II hypersensitivity**, where IgG autoantibodies are directed against platelet surface glycoproteins (GPIIb/IIIa). These antibody-coated platelets are then sequestered and destroyed by splenic macrophages. **Key Diagnostic Features in this Case:** 1. **Isolated Thrombocytopenia:** Platelet count is low (20,000/mL), but other cell lines (RBCs, WBCs) are normal. 2. **Bone Marrow:** Shows **increased megakaryocytes**, indicating the marrow is healthy and attempting to compensate for peripheral destruction. 3. **Prognosis:** Most childhood cases are self-limiting and resolve spontaneously within 6 months (as seen here, resolving in 2 months). --- ### Why Other Options are Incorrect: * **A. Antiphospholipid antibody syndrome:** Characterized by arterial/venous thrombosis and pregnancy loss; while thrombocytopenia can occur, it doesn't typically follow a viral illness in a child with spontaneous resolution. * **B. Disseminated intravascular coagulation (DIC):** This is a consumptive coagulopathy. You would expect abnormal PT/aPTT, low fibrinogen, and elevated D-dimer. The patient would appear clinically ill (sepsis/trauma). * **C. Hemolytic-uremic syndrome (HUS):** Characterized by a triad of microangiopathic hemolytic anemia (schistocytes on smear), thrombocytopenia, and acute renal failure, usually following bloody diarrhea (*E. coli* O157:H7). --- ### NEET-PG High-Yield Pearls: * **First-line treatment (if bleeding/severe):** Corticosteroids or IVIG. * **Chronic ITP:** Defined as thrombocytopenia persisting >12 months (more common in adults). * **Splenectomy:** The most effective definitive treatment for refractory ITP, as the spleen is both the site of antibody production and platelet destruction. * **Wet Purpura:** Presence of mucosal bleeds (e.g., mouth, gums) is a warning sign of life-threatening hemorrhage (intracranial hemorrhage).
Question 7: A patient presents with ecchymoses and petechiae all over the body and no hepatosplenomegaly. Which of the following statements is NOT true?
- A. Increased megakaryocytes in bone marrow
- B. Bleeding into the joints (Correct Answer)
- C. Decreased platelets in blood
- D. Disease resolves itself in 80% of patients in 2-6 weeks
Explanation: **Explanation:** The clinical presentation of petechiae and ecchymoses (superficial skin bleeds) without hepatosplenomegaly in a pediatric patient is a classic description of **Immune Thrombocytopenic Purpura (ITP)**. **Why Option B is the Correct Answer (The "NOT True" statement):** Bleeding into the joints (**Hemarthrosis**) is a hallmark of **coagulation factor deficiencies** (secondary hemostasis defects), such as Hemophilia. In contrast, platelet disorders like ITP present with **mucocutaneous bleeding** (petechiae, purpura, epistaxis, and gum bleeding). Hemarthrosis is extremely rare in ITP. **Analysis of Incorrect Options:** * **Option A (Increased megakaryocytes):** In ITP, platelets are destroyed peripherally by anti-platelet antibodies. The bone marrow responds by increasing production, leading to an increased number of megakaryocytes. * **Option C (Decreased platelets):** Thrombocytopenia (isolated low platelet count) is the defining laboratory feature of ITP. * **Option D (Self-resolution):** Acute ITP in children is typically a self-limiting condition. Approximately 80% of cases resolve spontaneously within 2–6 months (often following a viral infection) without requiring aggressive intervention. **Clinical Pearls for NEET-PG:** * **ITP Diagnosis:** It is a diagnosis of exclusion. The absence of hepatosplenomegaly and lymphadenopathy is crucial to rule out leukemia. * **First-line Treatment:** If treatment is indicated (usually when platelets <20,000/µL or significant bleeding occurs), **Corticosteroids** or **IVIG** are the preferred agents. * **Chronic ITP:** Defined as thrombocytopenia persisting for >12 months. * **Platelet vs. Coagulation Bleeding:** * *Platelet defects:* Immediate bleeding, petechiae, mucosal involvement. * *Coagulation defects:* Delayed bleeding, deep hematomas, hemarthrosis.
Question 8: In a newborn, Harlequin skin change is due to what underlying condition?
- A. Polycythemia
- B. Septicemia
- C. Autonomic dysfunction (Correct Answer)
- D. Ichthyosis
Explanation: **Explanation:** **Harlequin Color Change** is a transient, benign phenomenon seen in approximately 10% of healthy newborns, typically between the 2nd and 5th day of life. 1. **Why Autonomic Dysfunction is Correct:** The condition is attributed to the **immaturity of the hypothalamic centers** that control peripheral vascular tone. This leads to temporary **autonomic instability**, causing a sharp midline demarcation where one half of the body appears deep red (dependent side) and the other half appears pale (upper side) when the infant is placed on their side. Gravity causes blood to pool in the lower half due to dysregulated capillary tone. 2. **Why Other Options are Incorrect:** * **Polycythemia:** Presents as generalized "plethora" (ruddy, dusky red skin) throughout the body, not a midline-demarcated color change. * **Septicemia:** While sepsis can cause mottled skin (cutis marmorata) or peripheral cyanosis, it is accompanied by systemic signs like lethargy, poor feeding, and temperature instability. Harlequin change occurs in otherwise healthy infants. * **Ichthyosis:** Specifically "Harlequin Ichthyosis" is a severe genetic skin disorder characterized by thick, plate-like scales and ectropion. It is a structural skin defect, not a transient vascular phenomenon. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** The episodes typically last from 30 seconds to 20 minutes. * **Management:** It is a **benign, self-limiting** condition. No treatment is required other than reassurance and changing the baby's position. * **Differential:** Do not confuse this with *Harlequin Ichthyosis* (genetic) or *Port-wine stain* (permanent capillary malformation). * **Trigger:** Most commonly seen when the infant is placed in a lateral recumbent position.
Question 9: A 3-year-old child presented with progressive anemia, jaundice, and failure to thrive. On examination, pallor and splenomegaly are seen. Peripheral smear showed normoblasts and small round intensely stained red cells. What is the likely diagnosis?
- A. Hereditary spherocytosis (Correct Answer)
- B. Thalassemia
- C. Sickle cell anemia
- D. Vitamin B12 deficiency anemia
Explanation: ### Explanation **1. Why Hereditary Spherocytosis (HS) is Correct:** The clinical triad of **anemia, jaundice, and splenomegaly** in a young child strongly suggests a chronic hemolytic process. The definitive clue lies in the peripheral smear: **"small round intensely stained red cells"** are **Spherocytes**. These cells lack central pallor because they have lost their biconcave shape due to defects in RBC membrane proteins (most commonly **Ankyrin**, followed by Spectrin). The presence of **normoblasts** (nucleated RBCs) indicates a robust compensatory bone marrow response to hemolysis. **2. Why Other Options are Incorrect:** * **Thalassemia:** While it presents with anemia and splenomegaly, the peripheral smear typically shows **microcytic hypochromic** cells, target cells, and basophilic stippling, not spherocytes. * **Sickle Cell Anemia:** Characterized by **sickle-shaped cells** and Howell-Jolly bodies. Splenomegaly is usually seen only in early childhood; later, "autosplenectomy" occurs due to repeated infarcts. * **Vitamin B12 Deficiency:** This is a **megaloblastic anemia** (macrocytic). The smear would show macro-ovalocytes and hypersegmented neutrophils, not spherocytes or jaundice from hemolysis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Most commonly Autosomal Dominant. * **Gold Standard Test:** Eosin-5-maleimide (EMA) binding test (Flow cytometry). * **Screening Test:** Osmotic Fragility Test (increased fragility). * **MCHC:** Characteristically **elevated** (>36 g/dL) due to relative dehydration of the cell. * **Complications:** Pigmented gallstones (calcium bilirubinate) and Aplastic crisis (associated with **Parvovirus B19**). * **Treatment of Choice:** Splenectomy (usually deferred until after age 5–6 to reduce sepsis risk).
Question 10: What is the hemoglobin level indicative of anemia in a child aged 2 to 5 years?
- A. Less than 14 g/dL
- B. Less than 11 g/dL (Correct Answer)
- C. Less than 12 g/dL
- D. Less than 13 g/dL
Explanation: **Explanation:** The definition of anemia in children is based on hemoglobin (Hb) thresholds that vary by age, reflecting the physiological changes in red blood cell mass and plasma volume during growth. According to **WHO criteria**, the cutoff for anemia in children aged **6 months to 5 years (60 months)** is a hemoglobin level of **<11 g/dL**. **Why Option B is Correct:** In the 2 to 5-year age group, the hematopoietic system has stabilized after the "physiological anemia of infancy," but the iron requirements remain high due to rapid growth. A value below 11 g/dL indicates that the oxygen-carrying capacity is insufficient for the metabolic needs of this age group. **Analysis of Incorrect Options:** * **Option A (<14 g/dL):** This is a normal range for newborns (who have high Hb due to fetal hemoglobin) or adult males. It is too high a threshold for toddlers. * **Option C (<12 g/dL):** This is the diagnostic cutoff for **children aged 12–14 years** and **non-pregnant adult females**. * **Option D (<13 g/dL):** This is the diagnostic cutoff for **adult males** (aged 15 years and above). **High-Yield Clinical Pearls for NEET-PG:** * **Newborn (at birth):** Anemia is defined as Hb **<13.5 g/dL**. * **6 months to 5 years:** Hb **<11 g/dL**. * **5 years to 11 years:** Hb **<11.5 g/dL**. * **12 years to 14 years:** Hb **<12 g/dL**. * **Most Common Cause:** Nutritional **Iron Deficiency Anemia (IDA)** is the most common cause of anemia in this age group worldwide. * **Mentzer Index:** (MCV/RBC count) <13 suggests Thalassemia trait, while >13 suggests Iron Deficiency Anemia—a frequent "distractor" in pediatric hematology questions.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free