zaki
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65-year-old woman presents to the hospital with petechiae, nosebleed, and vaginal bleeding. She had undergone hip replacement surgery for osteoarthritis and received 2 units of red cells 1 week earlier. There is no history of bleeding despite several dental extractions and four pregnancies. She takes no medications except for acetaminophen.
Physical examination reveals multiple petechiae and ecchymoses. A vaginal pack is soaked with blood. Vital signs are normal, and the patient is afebrile. No organomegaly is noted.
Laboratory studies:
Hematocrit 32%
Leukocyte count 5400/µL
Reticulocyte count 6%
Platelet count 1000/µL
Prothrombin time Normal
Partial thromboplastin time Normal
Plasma fibrinogen 400 mg/dL
Fibrin split products Negative
Serum creatinine 1.0 mg/dL
Peripheral blood smear shows no platelets and normal red cells.
The most likely diagnosis is:
A)Sepsis-induced thrombocytopenia
B) Disseminated intravascular coagulation
C)Post-transfusion purpura
D)Thrombotic thrombocytopenic purpura
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| alice8
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TTP :?:
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A i thik
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| alice8
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i am going to change my answer guys..it couldnt be TTP ...Except thrombocytopenia nothing is closer with TTP :roll: Sorry about the confussion ...It sounds like Post transfussion thrombocytopenia with this female patient 's clinical features
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| guest
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it looks like post transfusion purpura
because obviously it's not DIC [note absence of FDP] or TTP[ no renal or neurological manifestations] so remaining septic or post transfusion. patient is afebrile , so it's post transfusion 
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| carla
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Everything in the lab within normal limits more or less....but the antecedent of blood transfussion.....ring a bell? Post transfussion Purpura is correct 
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| zaki
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correct this is post trans purpura
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| zaki
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Post-transfusion purpura is characterized by the acute onset of severe thrombocytopenia 7 to 10 days after blood transfusion. The condition occurs almost exclusively in women. Previous pregnancies or red cell transfusions sensitize women to platelet-specific antigens. Upon transfusion, the patient has an amnestic alloimmune response to the platelet antigen. With the formation of the alloantibody and in the presence of soluble platelet antigens, the antibody mediates the immune destruction of the patient’s own platelets. This condition is most commonly seen in PlA1-negative persons (2% of the population), although other platelet alloantigens have been implicated in post-transfusion purpura. The diagnosis is established by the detection of antibodies to platelet-specific antigens. Therapy consists of high-dose intravenous gamma globulin or plasma exchange.
There are no clinical or laboratory indications that disseminated intravascular coagulation is causing the patient’s thrombocytopenia. Sepsis may lead to thrombocytopenia independent of associated disseminated intravascular coagulation, but this patient was afebrile and had no leukocytosis. Thrombotic thrombocytopenic purpura may be associated with severe thrombocytopenia and reticulocytosis. However, the absence of microangiopathic red cell changes makes thrombotic thrombocytopenia highly unlikely. Affected patients commonly have neurologic abnormalities, fever, and renal dysfunction.
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