CASE STUDY:
A 25-year-old woman feeling well at 36 weeks gestation in her first pregnancy was found to have the CBC shown in tab.1. No previous blood counts were available,
There was no history of excessive bruising or bleeding.
Her blood pressure was 140/90 mmHg.
Her blood pressure was 140/90 mmHg.
Her blood pressure was 140/90 mmHg.
Tab.1
Hb. conc10.7 g/dL
. TLC7.9x 10 3 /µL
Plt.count70 x 10 3 /µL
PBS;; Normal red cell & plt. morphology
Q1. What are the most likely conditions causing her thrombocytopenia?
Q2. What further investigations are required?
Marrow aspirate revealed a cellular sample with a normal number of megakaryocytes. Some degree of myeloid hyperplasia was noted, but erythroid activity was normal. Stainable iron was present, but reduced. The results of other tests are shown in tab.2
Tab.2
Test
Result
Reference range
PT
15 sec.
طبيعيnormal14-16
APTT
38 sec.
طبيعي30-38
Fibrinogen
1.6 g/L
طبيعي1.5- 4.0
Total s. bilirubin
10 µmol/L
2-17
Alanine transaminase
42 IU/L
10-40
Alkaline phosphatase
103 IU/L
طبيعي40-125
Reticulocytes
1.8 %
Urine & Electrolytes
Normal
Viral titres
No recent infection identified
Auto-antibodies
Negative
Coomb’s test
Negative
Urate
0.27 mmol/L
0.12-0.36
Urinary protein
Less than 0.2 g/24 hr.
Q3. Discuss these data & reach a working diagnosis?
Q4. Discuss the management you would recommend during the rest of her pregnancy?
A 25-year-old woman feeling well at 36 weeks gestation in her first pregnancy was found to have the CBC shown in tab.1. No previous blood counts were available,
There was no history of excessive bruising or bleeding.
Her blood pressure was 140/90 mmHg.
Her blood pressure was 140/90 mmHg.
Her blood pressure was 140/90 mmHg.
Tab.1
Hb. conc10.7 g/dL
. TLC7.9x 10 3 /µL
Plt.count70 x 10 3 /µL
PBS;; Normal red cell & plt. morphology
Q1. What are the most likely conditions causing her thrombocytopenia?
Q2. What further investigations are required?
Marrow aspirate revealed a cellular sample with a normal number of megakaryocytes. Some degree of myeloid hyperplasia was noted, but erythroid activity was normal. Stainable iron was present, but reduced. The results of other tests are shown in tab.2
Tab.2
Test
Result
Reference range
PT
15 sec.
طبيعيnormal14-16
APTT
38 sec.
طبيعي30-38
Fibrinogen
1.6 g/L
طبيعي1.5- 4.0
Total s. bilirubin
10 µmol/L
2-17
Alanine transaminase
42 IU/L
10-40
Alkaline phosphatase
103 IU/L
طبيعي40-125
Reticulocytes
1.8 %
Urine & Electrolytes
Normal
Viral titres
No recent infection identified
Auto-antibodies
Negative
Coomb’s test
Negative
Urate
0.27 mmol/L
0.12-0.36
Urinary protein
Less than 0.2 g/24 hr.
Q3. Discuss these data & reach a working diagnosis?
Q4. Discuss the management you would recommend during the rest of her pregnancy?
تعليق