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?

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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

References