Q.10 A 40 year old womenis admitted to hospital because of fever,headache confusion and jaundice for 1 week.She underwent hysterectomy 2 months ago and began estrogen replacement therapy and begin with ethyniyl estradiol and a progestin.On admission her temperature is 37.8 C ( 102 F ),blood pressure is 140/90 mm Hg,pulse is 98/min.She appers disoriented to time and place.Physical examination reveals jaundice sclerae and skin,pupura on the trunk and bleeding gums.A guaiac test is positive for occult blood in stools.Blood and urine culture are negative,but urine analysis reveals hemoglobinuria.Blood studies show: Hematocrit 28 percent RBC’s 2.5 million/mm3 Leukocytes 10000 mm3 platelets 10000 mm3 SERUM BUN 40mg/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 normal limits,fibrin split products and coombs test are negative.A peripheral blood smear shows schistocytes,helmet cells and triangle cells.Which of the following is most likely diagnosis? A ) DIC B ) Evans syndrome C ) Hemolytic uremic syndrome D ) ITP E ) Malignant hypertension F ) Thrombotic thrombocytopenic purpura
Posted on: Sun, 14 Jul 2013 18:21:05 +0000
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