A previously healthy 34-year-old female 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:
Test |
Value |
Normal Adult Range |
Haemoglobin* |
78 G/L |
115 – 155 |
White Cell Count* |
14.5 x 109 / L |
4.0 – 11.0 |
Platelets* |
43 x 109 /L |
150 – 300 |
Blood picture:
Thrombocytopaenia, fragmented red cells and reticulocytosis.
The combination of thrombocytopenia, haemorrhage and a MAHA-like blood film all suggest the following differentials: