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  #1  
Old 01-14-2010
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Question Sickle Cell Patient with a Rash!

A 7 year old child with history of sickle cell disease presented to the ER with widespread petichial rash over the lower limbs and trunk and high grade fever. OE: the child was stuporous and had yellow sclera

Labs showed:
  • WBC 12000 / cubic mm
  • RBC 5 million / cubic mm
  • Hb 7 g/dl
  • Blood film showed microcytosis, hypochromia, and fragmented RBCs
  • Platelets 25000 / cubic mm
  • BUN 55 mg/dl and creatinine 1.6 mg/dl
  • Urine positive for hemoglobin and protein 3+

What is the most likely diagnosis?
a- DIC
b- HUS
c- HSP
e- Meningococcemia
f- Parvovirus B19 infection
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  #2  
Old 01-14-2010
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This is one difficult quesetion, could be a or b, but again, both are not associated with this kind of proteinuria.

I choose b
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Old 01-14-2010
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I also choose B
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Old 01-14-2010
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Don't want to be the odd one out, but i think it's F.

(B19)Fifth disease causing aplastic crisis in a sickle cell patient... i know the rash is supposed to be "slapped cheek" but there is rash on the rest of their body too....

If not, then my second choice would be HSP...
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Old 01-14-2010
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Arrow The correct answer

  • In DIC you should see fibrinogen and FDP results in the question and also renal failure and intavascular hemolysis are not characteristic.
  • In HSP you have palpable purpura rather than petichiae and unlikely to see the child in such a disastrous semi comatose status.
  • In meningococcemia you can have all of these but the fragmented RBCs and the hemolysis should point to a more likely diagnosis.
  • In Parvo B19 you have aplastic crisis but you unlikely to see jaundice, hemolysis, and renal failure.
I guess you now know what's the correct answer
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Old 01-14-2010
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Why the decreased platelet count??
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Old 01-14-2010
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Quote:
Originally Posted by DrSeddik View Post
Why the decreased platelet count??
Hemolytic Uremic syndrome characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure
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  #8  
Old 01-14-2010
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Why nobody is thanking me for this question
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  #9  
Old 01-14-2010
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Quote:
Originally Posted by Sarah-cali View Post
Why nobody is thanking me for this question
The question is very confusing that's why? I nearly hit a wall while I was reading it.

Ofcourse it's a typical USMLE question, they love to see heads going through walls.
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Old 01-14-2010
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Quote:
Originally Posted by Sarah-cali View Post
Hemolytic Uremic syndrome characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure
OOh ofcourse, I though you said HSP was the answer..
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  #11  
Old 05-15-2016
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I think it's HUS
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Hematology-, Pathology-, Renal-, Step-1-Questions

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