Hematology Case study
Ms, Chang, a 35-year-old woman, was seen by her physician. She complained of weakness, low grade fever, periods of forgetfulness, and memory loss for the last week or so. She denied any viral or bacterial illness prior to the onset of symptoms. She was on oral contraceptives but was not taking any other drugs. As Ms. Chang was questioned further, she indicated that she noticed a large number of bruises on her extremities. The patient’s symptoms continued to become even worse with frequent seizures, headaches, and dizziness. Her urinalysis results showed a 2+ protein and moderate blood. However, she had normal urinary volume. Her initial laboratory tests showed:
A CBC was ordered on the patient and the results were:
WBC: 8.9 x 109/L
Hemoglobin: 6.0 g/dL
Hct: 0.18 L/L
Platelet: 31 x 109/L
Reticulocyte count: 2.5%
Peripheral smear showed moderate schitocytes and polychromasia.
Questions
Summary the case
What are some conditions that result in the presence of schistocytes?
As she indicated a large number of bruises appeared on her extremities. What is the significance of the results of her platelet count and reticulocyte count?
Why might the physician order coagulation tests?
Ms. Chang’s coagulation results were only slightly prolonged. The fibrinogen levels were slightly decreased. What do these findings indicate about the underlying problem?
Consider what additional testing may be helpful in identifying the cause of the anemia.
The patient’s symptoms continued to become even worse with frequent seizures, headaches, and dizziness. Her urinalysis results showed a 2+ protein and moderate blood. However, she had normal urinary volume. Based on these results, what is the most likely condition associated with these clinical and laboratory results? Explain.
What is some key information pointing to diagnosis?
What is the pathophysiology of the disease?
What are the diagnostic tests for the disease?
What therapy and prognosis might be used?
What is the prevention of the disease?
Take home message (significance of the disease, symptoms, causes…)
