A previously healthy  34 year old woman is transferred to your hospital intubated and ventilated with a history of a prolonged generalized tonic-clonic convulsion. On arrival, she is deeply unconscious  with a GCS of 3, fixed dilated pupils, absent  tendon  reflexes and bilateral up-going plantar reflexes. An admission CT scan shows bilateral intracerebral haemorrhages. A full blood count report is as follows:

1) Hb 78 g/l                            (130-150),
2) WCC 14.5 x 106/mm3          (4.0-11.0), 
3) Platelets  43 x 106 /mm3      (150-300)

Blood picture:  Thrombocytopaenia, fragmented cells and reticulocytosis

Based on the history, CT scan and the hematology  report, provide three possible differential diagnoses

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College Answer

Thrombotic thrombocytopaenic purpura
Meningococcal meningitis with DIC …(although big bleed is unlikely)



This question is identical to Question 15.2 from the second paper of 2011.