IM
HIV - 12-23-07 17:25
A21-year-old man with no significant past medical history presents to office complaints of blood in his urine and mucosl bleeding while brushing his teeth.he has intermittent ringing in the ears he denies any drug use he has no family history of bleeding disorders.petechiae are noted in his oral cavity,as is dried blood in nostrils.
laboratory studies show the following
hematocrit 32%,white blood cell 8,000/mm3 with 60% neutrophils,PT 13seconds, PTT28 second,LDH 1,200u/i.elevated indirect bilirubin
combs test is ve+.abdominal examination is normal, and the peripheral shows spherocytes
what is the most likely diagnosis?
A)alport's syndrome
B)Bernard-soulier syndrome
C)felty's syndrome
D)Thrombotic thrombocytopenic purpura
E)Evaans' syndrome
F)ITP
HIV - 12-23-07 17:25
A21-year-old man with no significant past medical history presents to office complaints of blood in his urine and mucosl bleeding while brushing his teeth.he has intermittent ringing in the ears he denies any drug use he has no family history of bleeding disorders.petechiae are noted in his oral cavity,as is dried blood in nostrils.
laboratory studies show the following
hematocrit 32%,white blood cell 8,000/mm3 with 60% neutrophils,PT 13seconds, PTT28 second,LDH 1,200u/i.elevated indirect bilirubin
combs test is ve+.abdominal examination is normal, and the peripheral shows spherocytes
what is the most likely diagnosis?
A)alport's syndrome
B)Bernard-soulier syndrome
C)felty's syndrome
D)Thrombotic thrombocytopenic purpura
E)Evaans' syndrome
F)ITP
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#4
Re: IM 8401glacieres - 01-16-08 11:55 E ---------Evan's Syndrome
In this syndrome the manofesstations of thrompbocytopenia and anaemia are seperated by time, onset, course and duration.
Direct COOMB'S test is positive in these patients.The combination of positive coomb;s test and immune mediated haemolytic anaemia with no other known underlying etiology defines EVAN;S SYNDROME.
Manifestations of intravascular haemolysis is documented by raised LDH, presence of indirect hyperbilirubinemia and decreased haematocrit(N-45 to 50 in males and 40 in females)
Only manifestation of ITP is the presence of fragmented RBC'S----SCHISTOCYTES.But ITP is rare in adults accounting for only 10%.(Refer HPIM 16th Edition)
In TTP it;s SPHEROCYTES which are present and neurological symptoms are present in >90% of patients(REFER HPIM Page 679 16th edition).
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