A 12-year-old girl returns from a trip to Africa with her family and is found to have jaundice. She had been taking antimalarial medication as a prophylaxis. Upon examination, her complete blood count reveals a hemoglobin level of 80 g/L, and her blood film shows the presence of Heinz bodies and blister cells. What disorder is associated with these findings?
A 35-year-old woman, who underwent splenectomy three years ago for chronic ITP, visits the clinic with complaints of petechial rash and gum bleeding. Her blood test results show a WBC count of 6.3 ×109/L (normal diff), haemoglobin level of 115 g/L, and a platelet count of 3 ×109/L. The presence of accessory spleens has been ruled out. What would be the most suitable treatment option for her condition?
A 29-year-old woman with a medical history of recurrent miscarriages, previous stroke, and thrombocytopenia presents to the hospital with a painful and swollen right calf that has been bothering her for the past three days. Upon conducting a coagulation screen, the following results were obtained: Prothrombin time of 13 seconds (normal range: 11.5-15.5 seconds), thrombin time of 13 seconds (normal range: 13 seconds), and activated partial thromboplastin time of 78 seconds (normal range: 30-40 seconds). The APTT was not corrected when mixed with normal plasma. What could be the underlying cause of this clotting abnormality?
A 41-year-old man presents to the emergency department with melaena and haematemesis. He has a past medical history of immune thrombocytopenia and is not currently on any treatment. He does not drink alcohol.
Observations:
Heart rate 108 beats per minute
Blood pressure 92/58 mmHg
Respiratory rate 18/minute
Oxygen saturations 96% on room air
Temperature 37.1ºC
On examination, there is dried blood around the patient’s mouth. Ecchymoses are noted on his arms and abdomen. There is melaena per rectum. There are no signs of chronic liver disease.
Blood tests:
Hb 73 g/L Male: (135-180)
Female: (115 – 160)
Platelets 9 * 109/L (150 – 400)
WBC 8.2 * 109/L (4.0 – 11.0)
Na+ 137 mmol/L (135 – 145)
K+ 4.2 mmol/L (3.5 – 5.0)
Urea 5.2 mmol/L (2.0 – 7.0)
Creatinine 89 µmol/L (55 – 120)
CRP 4 mg/L (< 5)
Bilirubin 12 µmol/L (3 – 17)
ALP 38 u/L (30 – 100)
ALT 27 u/L (3 – 40)
γGT 44 u/L (8 – 60)
Albumin 38 g/L (35 – 50)
Prothrombin time 11 seconds (10-12)
What is the most appropriate treatment option to increase the platelet count, given the patient’s medical history and clinical presentation?
A 35-year-old African man, known to be homozygous for sickle cell disease, presents to the hospital with worsening shortness of breath, right-sided pleuritic pain and dry cough over the last 12 hours. Upon examination, she has a fever of 39 °C. Her respiratory rate is 28 breaths per minute. Oxygen saturation on room air is 88%. She is tachycardic and normotensive, and chest examination reveals expiratory wheeze throughout both lung fields.
Investigations:
Haemoglobin (Hb) 60 g/l 135–175 g/l
White cell count (WCC) 20 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 450 × 109/l 150–400 × 109/l
Chest X-ray New shadowing at right base
She is diagnosed with acute chest syndrome, possibly related to Mycoplasma infection.
What additional tests should be conducted to guide the management and prognosis of this patient?
A 45-year-old woman presents to the gynaecology ward with complaints of menorrhagia. Upon receiving the results of her initial investigations, the gynaecology team requests a medical review. The patient has a history of anaemia and was prescribed ferrous sulphate by her GP. However, she experienced severe abdominal pain and constipation when taking oral iron supplements and had discontinued the tablets on her own. She also complains of constant fatigue and breathlessness on exertion, which is limiting her daily activities.
The following investigations were conducted:
– Haemoglobin: 68 g/L (115-165)
– MCV: 74 fL (80-96)
– MCH: 26 pg (28-32)
– White cell count: 7.3 ×109/L (4-11)
– Neutrophils: 3.0 ×109/L (1.5-7)
– Lymphocytes: 3.0 ×109/L (1.5-4)
– Monocytes: 0.8 ×109/L (0-0.8)
– Eosinophils: 0.4 ×109/L (0.04-0.4)
– Basophils: 0.1 ×109/L (0-0.1)
– Platelet count: 566 ×109/L (150-400)
– Serum ferritin: 5 g/L (15-300)
The patient has been taking oral iron at a sub-optimal therapeutic dose for four weeks due to side effects. What is the next step in managing this patient?
A 25-year-old woman comes to the Emergency Department complaining of shortness of breath. She had a bone marrow transplant for Hodgkin’s lymphoma six months ago and requires regular blood transfusions. She suspects that she may be anemic and is requesting a transfusion to be arranged.
Investigations:
Haemoglobin (Hb) – 80 g/l (normal range: 120-160 g/l)
White cell count (WCC) – 2.8 × 109/l (normal range: 4.0-11.0 × 109/l)
Platelets (PLT) – 110 × 109/l (normal range: 150-400 × 109/l)
Neutrophils – 1.2 × 109/l (normal range: 2.5-7.58 × 109/l)
Blood film – unremarkable
Coombs’ test – negative
Epstein-Barr virus (EBV) bone marrow donor status – negative
EBV bone marrow recipient pretransplant status – negative
What type of blood should be arranged for this patient?
A 50-year-old woman is being evaluated after being diagnosed with a pulmonary embolism. She was recently hospitalized for a severe case of community-acquired pneumonia that required ventilation and ICU admission. Although she responded well to intravenous antibiotics, she experienced increased shortness of breath just before discharge. A CTPA was ordered, revealing a pulmonary embolism, and she was promptly started on dalteparin. What would be the most suitable course of action now?
A 45-year-old woman presents to the emergency department with acute abdominal pain and vomiting. She has a medical history of hypothyroidism and vitiligo. On examination, she has a fever, tachycardia, and tenderness in the right iliac fossa. She also has bruising and petechiae on her back and extremities and reports frequent nosebleeds over the past 2 weeks. Laboratory investigations reveal thrombocytopenia, leukocytosis, and elevated CRP. The surgical team recommends preparing her for theatre.
What is the appropriate next step in managing this patient?
A 23-year-old man awaiting stem cell transplant for acute myeloid leukaemia has become unwell over the past two days and arrives with a Glasgow Coma Scale of 4 in the emergency department. His girlfriend who is present with him reports that he has had severe headaches and been sitting in bed but gradually became more confused. He was struggling to breathe and began to seize causing her to call the ambulance.
On examination, he is intubated and has bilateral coarse crepitations. His pupils are reactive but he is sedated and does not respond to pain. There is papilloedema bilaterally and haemorrhages are seen in the right eye. He is warm and well perfused but his right arm is cold and pale. He is transferred to the intensive care unit.
Hb 115 g/l
Platelets 300 * 109/l
WBC 110 * 109/l
Troponin 12,345 (normal range <20)
CRP 60 mg/l
Chest x-ray bilateral pulmonary infiltrates, small right sided effusion
What medical treatment should be initiated to correct his underlying pathology?