A 40-year-old woman is admitted to the hospital because of fever, headache, confusion, and jaundice for 1 week. She underwent hysterectomy 2 months ago and began estrogen replacement therapy with ethinyl estradiol and a progestin. On admission. her temperature is 38.7 C (102 F), blood pressure is 140/90 mm Hg, pulse is 98/min, and respirations are 20/min. She appears disoriented to time and place. Physical examination reveals jaundiced sclerae and skin, purpura on the trunk, and bleeding gums. A guaiac stool test is positive for occult blood. Blood and urine cultures are negative, but urinalysis reveals hemoglobinuria. Blood studies show: Hematocrit 28% Red blood cells 2.5 million/mm3 Leukocytes 1O,000/mm3 Platelets IS,000/mm3 Serum BUN 40 mg/dL Creatinine 2.8 mg/dL LDH 800 U/L Bilirubin Total 4.0 mg/dL Direct 0.8 mg/dL Coagulation tests are within normallirnits; fibrin-split products and Coombs test are negative. A peripheral blood smear shows schistocytes, helmet cells, and triangle cells. Which of the following is the most likely diagnosis? (A) Disseminated intravascular coagulation (DIC) (B) Evans syndrome (C) Hemolytic-uremic syndrome (HUS) (D) Idiopathic (autoimmune) thrombocytopenic purpura (ITP) (E) Malignant hypertension (F) Thrombotic thrombocytopenic purpura (TTP) https://facebook/groups/medclick/
Posted on: Sun, 01 Jun 2014 06:29:53 +0000
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