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Thursday, September 18, 2014
Hemophilia and Inherited Bleeding Disorders
Can You Differentiate?
60yo male, hx of htn, negative for fevers, and anuria. Bone marrow aspiration unremarkable. Pt denies etoh use. All labs unremarkable EXCEPT for thrombocytes<20,000 as well as, loss of appetite, progressive weight loss, over 35lbs within 6 months, and a + ANA. Pt also denies recent blood transfusion. Spleen is non palpable, wnl. Pt has not been taking any Sulfa, Rifampin, Gold Salts, oral anti-diabetics, or Quinidines.
Newest labs have been drawn within last 24 hours however results are pending. Patient is currently on 40mg of Dexamethasone by mouth daily. Last year he had successfully been taking Prednisone daily and was tapered off, as his platelets began to climb. Upon recheck, when the Prednisone was d/c`d, his platelets, plummeted into the teens and pt was started on the Dexamethasone. Any ideas on this one? HUS? TTP? SLE? Autoimmune Hemolytic Anemia Immune Thrombocytopenia/Hodgkins? Sjogrens Syndrome? Would love some input.
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Madeline Heffner, BSN, RN
College of Medicine
University of Cincinnati