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Old 08-23-2012
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Question Generalized petechiae and bleeding?

A febrile 65-year-old man with prostatic hyperplasia and urinary retention develops endotoxic shock. Within 24 hours, he has oozing of blood from all needle puncture sites, extensive ecchymoses and petechiae, and gastrointestinal bleeding. Laboratory studies show hemoglobin concentration of 9 g/dL, platelet count 75,000/mm3, prothrombin time (PT) 20 sec, partial thromboplastin time, activated (aPTT) 50 sec, d-dimer positive. What is an unrelated disease that can produce a similar clinical picture of generalized petechiae and bleeding and similar lab investigation results?

a) Acute lymphoblastic leukemia (ALL)
b) Acute myeloid leukemia (M3)
c) Adenocarcinoma of pancreas
d) SÚzary syndrome
e) Thrombotic thrombocytopenic purpura
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  #2  
Old 08-23-2012
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Cc......Mucin from adenocarcinomas activates coagulation with DIC
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Old 08-23-2012
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b) acute myeloid leukemia (m3).....auer rods,when disseminated cause DIC
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Old 08-23-2012
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I guess its B)... aml (esp APML) is associated with DIC...
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Old 08-23-2012
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Default e) Thrombotic thrombocytopenic purpura

Quote:
Originally Posted by imgchuchu View Post
Cc......Mucin from adenocarcinomas activates coagulation with DIC
I would go with TTP. I know its not a classical presentation of TTP. but in TTP also there is excessive consumption of platelets which can predispose to DIC kinda condition.

@imgchuchu: can you more elaborate your answer. How mucin causes DIC. Don't have much knowledge about this. Meanwhile if mucin can cause DIC then do CF patients can also develop DIC?
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Quote:
Originally Posted by venky2600 View Post
b) acute myeloid leukemia (m3).....auer rods,when disseminated cause DIC
Yes you are right but in AML we have DIC but the question is asking a condition similar to DIC. May be i am wrong
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Quote:
Originally Posted by koolkiller88 View Post
Yes you are right but in AML we have DIC but the question is asking a condition similar to DIC. May be i am wrong
yeah ur right.....a condition similar to the above symptoms and lab investigations.( but not stating directly as DIC, as from the symptoms we gotta know the pt is in DIC...and as in AML too there will be similarcomplaints and lab)
as ALL and sezary can be eliminated easily i guess...anyways what's ur answer ?
let's wait for casandra answer
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yeah ur right.....a condition similar to the above symptoms and lab investigations.( but not stating directly as DIC, as from the symptoms we gotta know the pt is in DIC...and as in AML too there will be similarcomplaints and lab)
as ALL and sezary can be eliminated easily i guess...anyways what's ur answer ?
let's wait for casandra answer
My answer TTP
why?
1. I remember some concept of TTP and DIC
2. If it would be M3. Casandra wouldn't have posted this
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Quote:
Originally Posted by koolkiller88 View Post
My answer TTP
why?
1. I remember some concept of TTP and DIC
2. If it would be M3. Casandra wouldn't have posted this
yes, may be.......actually for me ttp,aml, and adenoca. of pancreas...all 3 are looking like answers.....i choosed aml from the 3( if we don't know the answer we have to answer something we guessed right)......ttp may be the right answer....
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I'd go with B
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Old 08-24-2012
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c) Adenocarcinoma of pancreas.
Would DIC have a low platelet count in AML?
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b) Acute myeloid leukemia (M3)
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Old 08-24-2012
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Quote:
Originally Posted by koolkiller88 View Post
My answer TTP
why?
1. I remember some concept of TTP and DIC
2. If it would be M3. Casandra wouldn't have posted this
But in TTP , pt and ptt wouldnt change .. If we want a condition mimicking
the labs also then it cant be TTP ...???

Correct me if i am wrong..
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Quote:
Originally Posted by koolkiller88 View Post
I would go with TTP. I know its not a classical presentation of TTP. but in TTP also there is excessive consumption of platelets which can predispose to DIC kinda condition.

@imgchuchu: can you more elaborate your answer. How mucin causes DIC. Don't have much knowledge about this. Meanwhile if mucin can cause DIC then do CF patients can also develop DIC?
@koolkiller
Of the options provided,AML(M3)and Adenocarcinomas can cause DIC.
Auer rods from M3 and mucin from adenocarcinoma activates unregulated coagulation which leads to DIC
BUT looking at the patients AGE,I elliminated Option B leaving me with Adenocarcinoma..

let's see what her answer is
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Pancreatic adenoCa
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Quote:
Originally Posted by imgchuchu View Post
@koolkiller
Of the options provided,AML(M3)and Adenocarcinomas can cause DIC.
Auer rods from M3 and mucin from adenocarcinoma activates unregulated coagulation which leads to DIC
BUT looking at the patients AGE,I elliminated Option B leaving me with Adenocarcinoma..

let's see what her answer is
I forgot to add your choice of TTP;
It's a disorder of primary hemostasis;it has nothing to do with the coagulation cascade so both PT and PTT are normal,no DIC but increased bleeding time from low platelets
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Quote:
Originally Posted by dr.nitowl View Post
But in TTP , pt and ptt wouldnt change .. If we want a condition mimicking
the labs also then it cant be TTP ...???

Correct me if i am wrong..
Ya then it would be B or C.
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Default correct answer

The answer is b) Acute myeloid leukemia (M3)

The blasts in acute myeloid leukemia have cytoplasmic granules rich in procoagulants and fibrinolytic factors. The clinical presentation is like DIC.

Option A (Acute lymphoblastic leukemia (ALL)) is incorrect. In ALL, the clinical features include lymphadenopathy and splenomegaly. DIC is not a feature of ALL.

Option C (Adenocarcinoma of pancreas) is incorrect. Adenocarcinoma of the pancreas could be associated with Trousseau syndrome, which includes migratory thrombophlebitis caused by thrombogenic substances released by the cancer cells. It involves reins and is patchy and migratory. The clinical picture is not like DIC.

Option D (SÚzary syndrome) is incorrect. This is a form of cutaneous T-cell lymphoma characterized by generalized exfoliative erythroderma and leukemic cells with cerebriform nuclei. DIC is not a clinical feature.

Option E (Thrombotic thrombocytopenic purpura) is incorrect. DIC is associated with fibrin clots, multiple coagulation factor deficiencies, activation of the fibrinolytic system, and thrombocytopenia. Therefore, conditions that produce thrombocytopenia, such as autoimmune thrombocytopenia and thrombotic thrombocytopenic purpura, do not explain all of the clinical and laboratory findings that are present in this patient.
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