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Case Study

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by

Lexo Kokrashvili

on 2 December 2011

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Transcript of Case Study

elevated reticulocyte count >1.5%. >5% strongly suggests haemolytic. Case 1 34 yr old male, SOB on excertion, unable to climb up on his 3rd floor appartment without stopping couple of times during last 2/52. Previously healthy and fit.
PMHx arthroscopic surgery 2 years ago for skiing injury in scotland.
Dhx occasional NSAIDS for headaches and knee pain
FHx mother breast ca 6 yrs ago, father and siblings healthy SHx non smoker, 2-3 pints a week, no illicit drugs.
O/E pale, non distressed at rest BP 140/76, P124, RR 22, T 36.7
icteric sclerae.
CVS ESM, chest clear, abdo SNT, no organomegaly, nil bruises, oedema or lymphadenopathy. Bloods:
Hb 6.9 hematocrit 16%, WCC 7.8 Plt 417. Blood film Reticulocytes 9.3%
U&E normal, Bil 123.2, ALT, ALP normal, LDH 2900U/L( 200-600), Haptoglobins normal, film-spherocytosis. Dx Anaemia, Cause? examination of blood film + reticulocyte count Should we measure haptoglobins for intravascular haemolysis? acute phase protein, increased MI, CA, infections. also 30% of transfused blood can hemolyse within 24hr and decrease haptoglobin levels increased after acute bleed or tx of hematinic deficiency.10% hered.
spherocytosis and 50% thalasemia minor will have normal reticulocytes. Clinical features-mild to fulminant. weakness, dispnoae, fatigue; angina, bowel infarction in elderly. Tx-pred 1mg/kg. response 4-7/7.once Hb 10 slow tapering to 0.5mg/kg over 4-6/52. then very slow to 5-10 mg over 3-4/12. Aza, ciclo in 50% prog 90% respond in 2-3/52. relapse 50% splenectomy 75% AIHA suspected, coombs positivepred 80mg Hct increased to 42%. tapering to 20mg-drop to 27%. increased but repeat tapering failed- splenectomy Thanks for attention, any questions? classified by Ab and T. warm IgG, cold IgM
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