A previously well 54 year old man presents with confusion. On examination a rash is noted ( a clinical photograph provided). Temperature 37.1 The initial blood results are provided below.
Venous biochemistry
|
Na |
135 |
mmol/L |
(135-145) |
|
|
K |
3.8 |
mmol/L |
(3.5-4.5) |
|
|
Urea |
18 |
mmol/L |
(2.9-8.2) |
* |
|
Cr |
177 |
mol/L |
(70-120) |
* |
|
Bilirubin |
45 |
mol/L |
(<20) |
* |
|
Haematology |
||||
|
Hb |
99 |
g/L |
(135-180) |
* |
|
WBC |
10.8 |
x 109/L |
(4.0-11.0) |
|
|
Plt |
26 |
x 109/L |
(140-400) |
* |
Blood film: Schistocytes
|
Coagulation |
|||
|
PT |
10 |
s |
(9-12) |
|
APTT |
29 |
s |
(24-39) |
|
Fibrinogen |
3.0 |
g/L |
(1.7-4.5) |
|
30.2 |
|||
a) What is the most likely diagnosis?
b) What treatment needs to be instituted urgently?
College Answer
a) What is the most likely diagnosis?
Thrombotic thrombocytopenic purpura
b) What treatment needs to be instituted urgently?
• Plasmapheresis
Discussion
This question closely resembles Question 7.2 from the second paper of 2009.
References