FRCPath Haem Part 1 MCQs-General Haem 464

A 62-year-old man is admitted with epistaxis, haematuria and widespread purpura. He has chronic ITP and has been receiving prednisolone for the last 5 days without response. His platelet count is 3 × 10⁹/L. CT brain is normal. He is scheduled for urgent endoscopy because of suspected upper gastrointestinal bleeding.

The consultant decides to administer IVIG.

Which ONE of the following statements regarding IVIG is MOST CORRECT?

A. If the platelet count remains below 50 × 10⁹/L after 24 hours, a second dose should routinely be administered irrespective of the patient's bleeding status.

B. Viral serology should ideally be obtained before IVIG because administration may subsequently lead to false-positive serological results.

C. IVIG should be withheld until screening for hepatitis B, hepatitis C and HIV has been reported because treatment may mask active infection.

D. Failure to achieve a platelet count above 50 × 10⁹/L within 24 hours excludes immune thrombocytopenia as the diagnosis.

E. Platelet transfusions should always be avoided in patients receiving IVIG because they rapidly neutralise its therapeutic effect.