I think this case does not have enough information to suspect the result like RBCs and Bone marrow result and I suggest the patient has sideroblastic anaemia.
بالنسبة لسؤال الاخ الفاضل هيماتولوجست:
اولا يجب التأكد من انبوبة الفحص هل هي لنفس المريض او لا . والتاكد من ان لا يوجد هناك اي تخثر ولو بسيط .
ثانيا: يجب عمل مسحة أو blood film للتأكد من عدد الصفيحات فقد يكون الجهاز اخطأ في العد والتأكد ايضا من عدم وجود platelat aggregation in the tail of the film
ثالثا يجب اخذ التاريخ المرضي للمريضة مع الفحص سريري
رابعا بما انها انثى قد تكون مصابة ب idiopathic thrombocytopenic purpura
Pancytopenia , do a peripheral smear to check for : macrocytes, hypersigmented nuetrophils , or giant staff cells . also to check for luekocytes morphology and maturation . Do a biochemistry check for liver function and LDH and B12 and folate level . lastely a BM examination to exclude , Megaloblastic anemia , MDS or aluekaemic luekaemia .
أنا مع دكتور TVision بما انها انثى يبقى احتمال كبير تكون مصاب ب
idiopathic thrombocytopenia purpura
وبما انها ما حتاجتش نقل صفائح عكس ما اظهره التقرير يبقى احتمال الجهاز أخطأ في العد يبقى ممن نعمل blood film + نعمل [COLOR="Red"]manual acount plateletes[/COLOR]
انا اسف يا جماعة بس كان فيه ظروف
انا شايف ان الشباب جاوبو الاجابات اللي عاوز اقولها
أولا قلب العينة كويس وادخلها ع الجهاز
ثانيا هشك في خطأ في سحب العينة ممكن تكون اتسحبت ببطئ وأسحب عينة أخري
ثالثا عمل فيلم دموي وأشوف ممكن اجد plt aggregation
لو خلاص الموضوع اثبته انه thrombocytopenia
اولا اشك في EDETA induced
ITP
وفي كلتا الحالتين الحالة مش هتاخد صفائح وهتبقي كويسة
hi every one platlate count shuld be repeated manualley
because this case is unresnabale
platalte count=64
that mean patiant is suffering from a cute bleeding
so as we know acute bleeding will lead to normocytic normochromic anemia
in this case Hb is normal,PCV is normal,RBC count is normal
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clinicalley if the platates is 64 there must be signes of internal or external bleeding or even bleeding tendency or admittied to surgury and this is my second question
?????????????????????????????????????????????????? ????????????
in this case we start our bleeding profile
starting up with bleeding time,clotting time,PT,,PTT,INR.TT
and second line investigationes
in case of EDTA induced aggregation, withdraw a new sample using sodium citrate as the anticoagulant, and multiply the platelet count result by 1.1
becuase Na citrate has dilution effect
موفقين
we are not disagreedd my teacher but this case has many question marks
and the informationes are not complete
if its passed to me sorry i had to talk to the physision
my question is still incoming
what about the signs of spontinues bleeding
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do i have to undergo bleedimg profile
or is the patiant in a good position and only he needs platlates transfusion
are there any signs of hemodilutuon physiological or pathological leads to thrombocytopenia
many many question marks
?????????????????????????????????????????????????? ?????????????????????????????????????????????????? ????????????????????????????????????????????????
ياجماعة أرجو توضيح امر ما
نقص الصفائح الدمويه يسبب نزيف هذا صحيح ولكن عند عدد كام يحدث نزيف؟
هل صفائح عددها 130 تسبب نزيف؟
لا لالالالالا
plt count from 100 to 150 not liable to bleeding
New researches prove that some healthy people have plt count in this range
specially Caucasian
While plt count from 50 to 100 usually not liable to bleeding So patient with chronic ITP with this range do not need treatment only follow up
But patient from 20 to 50 is liable to bleeding but it is NOT a must so pt may bleed and may not
plt below 20 it is critical thrombocytopenia and should be in ICU because commonly he will have bleeding internal or external and less commonly don't have bleeding
acute ITP specaily in children commonly plt count below 50 and they dont have bleeding
Worldwide the name of ITP is now a synonym of Immune thrombocytopenia
instead of immune thrombocytopenic purpura
because purpura and hemorrhage not common with this case
in the case even plt is 64 , commonly will not suffer from bleeding
Thank you
تعليق