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Read Article Summaries From Top Medical Journals
Anesthesia for a patient with Fanconi anemia for developmental dislocation of the hip: A case report
Revista Brasileira de Anestesiologia, July 31, 2014
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The rationale for microcirculatory guided fluid therapy
Current Opinion in Critical Care, May 2, 2014
Clinical evaluation of hyponatremia and hypovolemia in critically ill adult neurologic patients: contribution of the use of cumulative balance of sodium
Journal of Anesthesia, March 24, 2014
Predicting major blood transfusion during spine surgery
Northwestern Medicine News, August 4, 2014
Combination of thrombin-antithrombin complex, plasminogen activator inhibitor-1, and protein C activity for early identification of severe coagulopathy in initial phase of sepsis: A prospective observational study
Critical Care, January 14, 2014
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Question: A 20-year-old woman presents to her family practitioner for evaluation of progressive fatigue, lightheadedness, dyspnea on exertion, and epistaxis that began insidiously about 2 weeks ago. She also comments that her urine is dark.
- Medical history: Significant only for intermittent epistaxis dating back to childhood, which had never been evaluated. She denied easy bruising or bleeding gums; her menstrual flow was described as “heavy” since menarche and throughout adolescence.
- Family history: Benign.
- Surgical history: Significant for a cesarean hysterectomy 2 years ago due to postpartum hemorrhage in the recovery room which could not be controlled pharmacologically or with uterine artery ligation. Patient reported a normal “blood count” at her routine postpartum visit. The in-office hematocrit was 15%. A peripheral blood smear revealed decreased platelets, spherocytes and a reticulocyte count of 10.0%. The direct Coomb’s test was positive.
Additional admission labs at a community hospital were significant for the following:
- HCT: 16.2%
- WBC count: 7400
- Neutrophil count: 53%
- Platelet count: 62000
- Reticulocyte count: 10.7%
- PT/PTT: Normal
- LDH: 532 IU/L
- Indirect bilirubin: 4.9 mg/dL
- Haptoglobin: 9 mg/dL
The patient underwent a slow transfusion with PRBCs. Based on the initial evaluation, what is the most likely diagnosis?