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Clinical Case 2
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A 24-year-old woman presents to your office with a bruise on her anterior tibia, which she noticed after bumping into a coffee table. She is G1 P0, at 39 weeks gestation. She has been well during her pregnancy and has had appropriate prenatal care. She has no other medical history, does not smoke or drink alcohol, and takes only prenatal vitamins. Her physical exam is unremarkable with the exception of an 8 cm bruise over her right anterior tibia. You obtain the following lab tests: CBC, which demonstrates WBC 9,000/mm3, hemoglobin 11.8 g/dL, and platelet count 95,000/ mm3; negative urinalysis; and normal liver enzymes.



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What is your next step?
A)Recommend immediate delivery by cesarean section as the infant likely has thrombocytopenia as well, and is at high risk for intracranial hemorrhage.
B)Recommend immediate delivery by cesarean section as this disorder will likely progress to eclampsia.
C)Recommend close observation, and reassure the patient that this is typically a self-limited condition.
D)Start prednisone, 1 mg/kg daily, and taper slowly over the next 6 weeks.
E)Recommend splenectomy as soon as possible after delivery.







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