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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
Tissue oxygen saturation and finger perfusion index in central hypovolemia: Influence of pain
Critical Care Medicine, March 23, 2015
Penn Medicine researchers discover possible new general anesthetics
Penn Medicine, January 22, 2015
Researchers make breakthrough on new anesthetics
American Society of Anesthesiologists News, January 21, 2015
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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?