pradsdoc
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A 40 year old man is brought to the emergency department because of hallucinations for 24 hours, he ended binge drinking 3 days ago. He has a history of type 2 diabetes and hypertension. He takes maedications but does not remeber the names of the drugs. His temp is 37.8, pulse 110, BP165/100. He is disoriented, tremulous and diaphoretic. The liver measures 16cm and is tender to palpation. Lab shows : HB 11.2
MCV 103
wbc 5000
plt 50, 000
prothrombin time 15 sec
Serum bilirubin 1.3
AST 120
Likely explanation for these findings ?
1. Adrverse drug reaction.
2. Hypersplenism
3. Myelophthisic marrow.
4. peripheral destruction of cells
5. Suppression of bone marrow production
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| Justice
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(2)?
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| doc_clotaire
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Very Hard question !
Looks like TTP to me ( fever , anemia , trombocytopenia , neurologic abn , liver dysfuntion ( usually it is renal dysfuntion but can affect the liver too )
My best guess is
4. peripheral destruction of cells
That 's only my opinion , any more input is WELCOME
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| Justice
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I agree, the Q is hard.
Does TTP cause leukopenia? I guess it does not...
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| Justice
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And I would like to see some petechial hemorrhages to consider TTP...
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| doyoudig
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5. Suppression of bone marrow production
Is my answer, if you look u notice that all cell lines are Low, he just wnet of a drinking binge n his MCV is high, Liver enlarged. Folate def can cause BM depression
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| nadiabarati
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wbc is 5000! It's not leukopenia!
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| doc_clotaire
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Thanks for reading my mind nadiabarati . I was just exactly about to put that down .
Hey doyoudig , Are you saying that Folate deficiency can cause APLASTIC ANEMIA ( same as BM supression ) I know that it can cause megaloblastic anemia not BM supression .
Are u sure about that ? Can you show me your sources PLEASE ?
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| sprint123
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Tricky question!!!
It cannot be BMS since HB is 11.2 and WBC count is normal.Clotaire's TTP is a possibility but I am thinking of hepatic encephalopathy for his CNS symptoms and hypersplenism for his decreased platelet counts.
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| doc_clotaire
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It could be a possibility too.......let 's see !
so pradsdoc , What is the correct answer ?
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| doyoudig
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soory guys i see that now completely missed Hb value n ur rite Wbc count not that low
let have the answer doc!!!
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| sprint123
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When looking at this question again--I have a second opinion.
Patient is in delirium tremens-alcohol withdrawal symptoms-which implies he is a chronic alcoholic which is evident by MCV value.Alcohol induced BMS can be a possibility in which thrombocytopenia may be the only or initial feature.
Regarding my prev answer with hypersplenism,patient must have atleast splenomegaly to signify portal hypertension.
I think all the asnwers have been discussed!
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| doyoudig
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we have reasoned!! what's the answer dude?
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