A 50-year-old woman seen in the emergency department for an acute onset of slurred speech and confusion. This was preceded by abdominal cramps and diarrhea. She has no medical problems and doesn’t take any medication. Her temp 38.9, Bp 180/100, pulse 110. She is confused and disoriented to time and place. Labs Hb: 8.5, platelets: 30000, LDH: 800, leukocyte count: 8000, creatinine: 3.5, Coombs test: negative. Which of the following is the single most appropriate initial treatment?
سؤال مجاني 6 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة: D. plasma exchange
She has the full TTP pentad: Coombs-negative haemolytic anaemia (high LDH), thrombocytopenia, renal failure, fever and confusion. TTP is an emergency, and first-line treatment is plasma exchange (with corticosteroids), started as soon as the diagnosis is made. The diarrhoea prodrome may suggest HUS, but the neurological features and fever point to TTP.
- Rituximab is for refractory/ADAMTS13-low disease.
- Platelet transfusion should be avoided because it fuels thrombosis.
- Antibiotics play no role and are avoided in STEC-HUS.
- المصدر
- HEME-05 Platelet Disorders [Notes].pdf · p. 20
Step Up To Medicine 6th, 2024 (Platelet disorders).pdf · p. 5
Step Up To Medicine 6th, 2024 (Platelet disorders).pdf · p. 6 - المحاضرة
- MAHA · Hematology · Module C
- ظهر في
- Hema bank · MED41 ♂ EOM C · MED41 ♀ EOM C