40-year-old woman with thrombocytopenia

4370 Views 4 Replies 4 Participants Last post by Taiyakikung, Feb 27, 2011

Taiyakikung

Discussion Starter · Feb 26, 2011

This is my first Thread

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A 40-year-old woman has had a week long course of fever and mental confusion. Physical examination shows T 38.2 C, P 100/minute, RR 20/minute, and BP 100/60 mm Hg. She has widespread petechiae of skin and mucosal surfaces. Laboratory studies show her serum urea nitrogen is 52 mg/dL with creatinine 5.3 mg/dL. She has a hemoglobin of 12.2 g/dL, hematocrit 36.8%, MCV 93 fL, platelet count 19,000/microliter, and WBC count 8180/microliter. Schistocytes are seen on her peripheral blood smear. Her condition deteriorates rapidly following platelet transfusion. At autopsy, pink hyaline thrombi are found in small myocardial arteries. Which of the following is the most likely diagnosis?

A Disseminated intravascular coagulopathy
B Idiopathic thrombocytopenic purpura
C Thrombotic thrombocytopenic purpura
D Trousseau syndrome
E Warm autoimmune hemolytic anemia

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Taiyakikung

Discussion Starter · #5 · Feb 27, 2011

You all got it right

.It's TTP
The classic TTP "pentad" of signs and symptoms includes
(1) thrombocytopenia, which is usually moderate or severe with an associated increase in bone marrow megakaryocytes;
(2) microangiopathic hemolytic anemia with a blood smear showing schistocyte as well as an extremely high serum lactic dehydrogenase (LDH) level;
(3) renal insufficiency, which is generally mild with moderate increases in serum creatinine and urine protein levels;
(4) fever; and
(5) neurologic abnormalities, which range from mild headache and disorientation to severe symptoms such as hemiparesis, seizures, focal neurologic deficits, coma, and death

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