IM 2-15 Hematology

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IM 2-15 Hematology

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DrVirgo
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06/11/07 - 07:14 PM

A 40 year old womand presents to her physician's office with a rash on her legs for the past 4 days. She recalls a recent respiratory infection. On examination, there is a small amount of blood in her nostrils. There are several hemorrhagic bullae in her oral cavity. Her lungs are clear, cardiac examination is unremarkable, and her abdomen is soft with no palpable spleen or liver. Both lower extremities have multiple dark blue ecchymoses. Lab analysis reveals:

Leukocyte count: 9000/mm3
Hemoglobin: 10.1 g/dL
Platelets: 9000/mm3
Peripheral Smear: Reticulocytosis with normal erythrocytes and megathrombocytes

An Ultrasound exam is negative for masses or fluid collections. Which of the following is the most appropriate next step in management?

A. Cryoprecipitate
B. Immunoglobulins
C. Prednisone
D. Plasmapheresis
E. Splenectomy

What does she have and what is the:
1. First line treatment?
2. Treatment for bleeding patient with this disease?
3. Treatment for SEVERE cases?

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prathapdoctor
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06/11/07 - 07:37 PM

first line treatment - Prednisolone, in prednisolone nonresonders - splenectomy, if the patient does not respond even after splenectomy - we must go for imunosupreesive therapy.

treatment of bleeding patient is giving intravenous immunoglobulins.

DrVirgo
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06/12/07 - 07:29 AM

Answer: C
1. First line treatment? -Prednisone
2. Treatment for bleeding patient with this disease? Immunoglobulin
3. Treatment for SEVERE cases? Splenectomy

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Justice
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06/12/07 - 10:15 AM

DrVirgo wrote:
Answer: C
1. First line treatment? -Prednisone
2. Treatment for bleeding patient with this disease? Immunoglobulin
3. Treatment for SEVERE cases? Splenectomy

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oggn
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06/12/07 - 08:06 PM

life threatening bleeding-platelet transfusion

krsna
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06/12/07 - 08:54 PM

in patients with patelet count <10000 the treatment of choice is IVIG...that wud make my answer to the ques B...

pls corect me if im wrong

damngood
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06/12/07 - 10:54 PM

agree with krsna
life threatening bleeding rx=iv gamma globulin
severe cases rx=prednisolone

splenectomy if pts refractory to medical rx

DrVirgo
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06/13/07 - 10:24 AM

THe correct given answer is C. Explanation as above.

krsna wrote:
in patients with patelet count <10000 the treatment of choice is IVIG...that wud make my answer to the ques B...

pls corect me if im wrong

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