Aashi
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A 28-year-old female comes to the emergency department with a headache and fever. She has not had any recent infections, nor has she been exposed to any drugs. Her medical history is unremarkable. On examination, the patient appears lethargic. Her temperature is 100.5 F, pulse is 100/minute, blood pressure is 130/85 mm Hg, and respirations are 18/min. Her conjunctivae are yellowish, and scattered petechiae are noted on the lower extremities. The liver and spleen are not enlarged.
Laboratory studies show the following results: WBC 12,000/mm3; hematocrit 27%; platelets 14,000/mm3; bilirubin 4.5 mg/dL; direct bilirubin 0.5 mg/dL; BUN 40 mg/dL; creatinine 3.5 mg/dL. PT, fibrinogen, and PTT are all normal. Her peripheral blood smear shows fragmented red blood cells.
What is the most effective treatment for this patient?
(A) Splenectomy
(B) Glucocorticoids
(C) Plasmapheresis
(D) Intravenous immunoglobulins
(E) Platelet transfusion
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| prathapdoctor
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TTP - Plasmapharesis.
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| CocaCola
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| dr.wad
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TES ( C )
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| anjushree
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yes TTP-----PLASMAPHARESIS
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| Aashi
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Answer:
(C) Plasmapheresis
Explanation:
This woman has a combination of hemolytic anemia with fragmented RBCs on peripheral smear; thrombocytopenia; fever; neurologic symptoms; and renal dysfunction -- a classic pentad of symptoms that characterizes thrombotic thrombocytopenic purpura (TTP). Approximately 90% of patients will respond to plasmapheresis. Patient should be emergently treated with large-volume plasmapheresis. Sixty to 80 mL/kg of plasma should be removed and replaced with fresh-frozen plasma. Treatment should be continued daily until the patient is in complete remission. Platelet transfusions in patients with TTP are contraindicated and can be associated with acute clinical deterioration. Antiplatelet agents, splenectomy, intravenous immunoglobulin, and immunosuppressive agents have not been of reliable benefit to patients with TTP. Each is less effective than plasmapheresis. Glucocorticoids are useful in patients if plasmapheresis does not work.
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