doc_clotaire
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A 21-year-old man with no significant past medical history presents to
office with complaints of blood in his urine and mucosal bleeding
while brushing his teeth. The patient complains of intermittent
"ringing in the ears." He denies any drug or alcohol use. He has no
family history of bleeding disorders. Petechiae are noted in the oral
cavity, as is dried blood in the nostrils.
Laboratory studies show the following:
Hematocrit 32%; white blood cell count 8,000/mm3 with 60% neutrophils;
platelet count 13,000; PT 13 seconds; PTT 28 seconds; LDH 1,200 U/L;
elevated indirect bilirubin.
Coombs' test is positive; abdominal examination is normal; and the
peripheral smear shows spherocytes.
What is the most likely diagnosis?
(A) Alport's syndrome
(B) Bernard-Soulier syndrome
(C) Felty's syndrome
(D) Thrombotic thrombocytopenic purpura
(E) Evans' syndrome
(F) Idiopathic thrombocytopenic purpura (ITP)
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| nadiabarati
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E
ITP + autoimmune hemolytic anemia = Evan syndrome
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| sprint123
Forum Guru
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| doc_clotaire
Forum Guru
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Answer:
(E) Evans' syndrome
Explanation:
Evans' syndrome is the association of autoimmune hemolysis with
autoimmune thrombocytopenia. It is treated initially with steroids and
may occasionally need splenectomy to control the disease.
Alport's syndrome is the congenital association of glomerulonephritis
with sensorineural hearing loss and ocular problems.
Bernard-Soulier syndrome is a functional platelet disorder presenting
with platelet-related bleeding with a normal platelet count.
Felty's syndrome is the association of rheumatoid arthritis with
neutropenia and splenomegaly. It is occasionally associated with
thrombocytopenia. This patient has no history of rheumatoid arthritis,
and the spleen and neutrophil count are normal.
ITP would not give the evidence of hemolysis that is present here,
such as an increased bilirubin, positive Coombs' test, high LDH, or
anemia. This patient does not have the renal failure or fever
associated with TTP. In addition, TTP should give fragmented red cells
on peripheral smear.
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| tongsaa
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why evan's syndrome will have tinnitus?
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| hanwin
Forum Senior
Topics: 6
Posts: 157
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symptom of anaemia.
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