Question:hard
18/M. Hepatosplenomegaly, Hb 7 gm%, LN+, WBC 50K, Platelets 30, petechiae, purpura, fatigue. What is the most appropriate management?
18/M. Hepatosplenomegaly, Hb 7 gm%, LN+, WBC 50K, Platelets 30, petechiae, purpura, fatigue. What is the most appropriate management?
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Young patient, high WBC with anaemia + thrombocytopenia + nodes + hepatosplenomegaly = ALL; pick the steroid + vinca alkaloid induction.
Updated On: Jun 22, 2026
- Cytarabine + iso?
- IVIG x 2 days
- Prednisolone + Vinblastine
- Radiotherapy to LN
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The Correct Option is C
Solution and Explanation
Diagnosis-driven approach. Before choosing a drug, name the disease. The blood counts tell a clear story: high WBC (50,000) with simultaneous anaemia (Hb 7) and thrombocytopenia (platelets 30,000, hence the petechiae and purpura). When one lineage is grossly elevated while the other two are suppressed in a young person, the marrow is being crowded out by a proliferating clone - acute leukaemia. The added findings of lymphadenopathy and hepatosplenomegaly in an 18-year-old point specifically to Acute Lymphoblastic Leukaemia, where lymph node and visceral infiltration are typical.
Management then follows directly from the diagnosis. ALL induction is built on a steroid plus a vinca alkaloid (with asparaginase and an anthracycline). Of the four choices, only Prednisolone + Vinblastine matches this lymphoid-leukaemia induction backbone.
Ruling out the distractors quickly:
• Cytarabine-based therapy belongs to AML, not ALL.
• IVIG is reserved for immune thrombocytopenic purpura, which shows isolated low platelets - not a high WBC with organomegaly.
• Nodal radiotherapy is a focal treatment for lymphoma and is useless against marrow-based, blood-borne leukaemia.
So the most appropriate management is Prednisolone + Vinblastine (Option C).
Management then follows directly from the diagnosis. ALL induction is built on a steroid plus a vinca alkaloid (with asparaginase and an anthracycline). Of the four choices, only Prednisolone + Vinblastine matches this lymphoid-leukaemia induction backbone.
Ruling out the distractors quickly:
• Cytarabine-based therapy belongs to AML, not ALL.
• IVIG is reserved for immune thrombocytopenic purpura, which shows isolated low platelets - not a high WBC with organomegaly.
• Nodal radiotherapy is a focal treatment for lymphoma and is useless against marrow-based, blood-borne leukaemia.
So the most appropriate management is Prednisolone + Vinblastine (Option C).
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