P4 CASE SCENARIO

Question 1

A 30-year-old woman came to A&E
after having a seizure (convulsion) at work. She has experienced similar episodes in the past and complained of increased fatigue. She first noticed these symptoms several weeks ago but has only recently sought care. Physical Examination:
Temperature: 39.30C; Pulse; 126/min and regular. Skin: multiple petechiae
observed; No hepato-splenomegaly; Neurologic examination: normal.
CBC: Hb:11.0g/dl; Reticulocytes: 4.0%; Platelets: 54,000/cumm (54.0x 109/L).
Peripheral Blood Smear (PBS): Schistocytes (fragmented RBC), helmet cells.
PT and PTT were normal, serum fibrinogen concentration was normal.
Urinalysis: proteinuria.
Q1: what is your diagnosis ?

Answer 1

thrombotic
thrombocytopenic purpura (TTP).

Question 2

Q2 : how do you treat this case ?

Answer 2

-Plasma exchange with fresh frozen plasma
-Glucocorticoids and antiplatelet drugs

Question 3

. A 10-year-old boy is admitted to the hospital because of fever and a petechial
rash. Pertinent laboratory findings include a platelet count of 50,000/μL(50x109/L), prothrombin time (PT) of 18 seconds (ref. range 11.5-15) seconds),activated partial thromboplastin time (aPTT) of 51 seconds (ref. range 35-45
seconds), thrombin time (TT) of 18 seconds (ref. range 12-17 seconds), factor VIII level of 14% (normal 60%-178%).
what is your diagnosis ?

Answer 3

Disseminated intravascular coagulation (DIC)

Question 4

A 43-year-old man comes to the hospital due to recurrent episodes of fever and sore throat despite multiple courses of antibiotic therapy. For the past several months, he has also felt “run down” and fatigued all the time. His wife adds that he bruises easily and has had
bleeding gums on several occasions. His temperature is 37.8 C (100.2 F). On examination,
he has mucosal pallor, pharyngeal erythema, and multiple ecchymoses on his extremities. His peripheral blood smear is shown in the image below .
what chromosomal abnormality is most likely to be found ?

Answer 4

t(15;17)