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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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A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: A 3-year prospective cohort study.
Critical Care, August 16, 2013
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
Local anaesthetics: 10 essentials
European Journal of Anaesthesiology, October 10, 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?