Managing Donor Complications and Blood Products

When a donor develops complications, it is important to assess how to manage both the donor and the blood products from the donation. In such cases, the blood products should be recalled until further testing and clarification of the donor’s illness. It is crucial to prevent the release of any of the blood products. However, the donor should not be immediately struck off the register until further testing results are available. It is important to take these precautions to ensure the safety of the blood supply and prevent any potential harm to recipients. Proper management of donor complications and blood products is essential to maintain the integrity of the blood donation system.

Interpreting Blood Results for Anaemia: Understanding the Relationship between Haemoglobin and MCV

When interpreting blood results for anaemia, it is important to understand the relationship between haemoglobin and mean corpuscular volume (MCV). A low haemoglobin and reduced MCV may indicate iron deficiency anaemia secondary to menorrhagia, which is a common cause of microcytosis. Treatment for this would involve managing the underlying menorrhagia and supplementing with iron. On the other hand, a low haemoglobin and raised MCV may indicate macrocytic anaemia, commonly associated with vitamin B12 or folate deficiency. It is important to note that a normal haemoglobin with a reduced MCV or a normal haemoglobin and MCV is unlikely in cases of significant symptoms and abnormal bleeding. Understanding these relationships can aid in the diagnosis and management of anaemia.

Kallmann’s Syndrome and its Differential Diagnosis

Anosmia and primary amenorrhoea are two symptoms that may indicate the presence of Kallmann’s syndrome. This condition is characterized by the underdevelopment of the olfactory bulb, which leads to a loss of the sense of smell, and the failure to produce gonadotrophin releasing hormone. As a result, low levels of follicle-stimulating hormone and luteinising hormone may cause a partial or complete failure to enter puberty in women.

Congenital adrenal hyperplasia, on the other hand, may cause electrolyte imbalances, but it is typically associated with abnormal female virilization. Prolactinoma, a type of pituitary tumor, is usually linked to secondary amenorrhoea. Meanwhile, thyrotoxicosis, a condition characterized by an overactive thyroid gland, may cause menstrual cessation, but it is less likely to be the cause of primary amenorrhoea, especially in the absence of hyperthyroidism symptoms.

In summary, Kallmann’s syndrome should be considered as a possible diagnosis in patients presenting with anosmia and primary amenorrhoea. However, other conditions such as congenital adrenal hyperplasia, prolactinoma, and thyrotoxicosis should also be ruled out through proper evaluation and testing.

The patient has sickle cell disease and a history of recurrent infections, indicating long-term damage to the spleen. The blood film shows signs of splenic disruption, such as Howell-Jolly bodies, and a low lymphocyte level, which may be due to reduced lymphocyte storage capacity in the shrunken spleen. This is different from a splenic sequestration crisis, which is an acute pediatric emergency. The current admission may be an acute chest pain crisis, but it is not the cause of the recurrent infections. The patient does not have acute lymphoblastic leukemia, as there is no evidence of blastic cells or pancytopenia. Advanced HIV is a possibility, but the blood film suggests sickle cell disease. While the patient is at risk of an aplastic crisis, it typically occurs in younger patients after a parvovirus B19 infection, which is not present in this case.

DDAVP for Increasing von Willebrand Factor

DDAVP is a medication that can be administered to increase the amount of von Willebrand factor in the body, which is necessary for surgical or dental procedures. This medication can increase plasma von Willebrand factor and factor VIII concentrations by two to five times. The mechanism of action involves the induction of cyclic adenosine monophosphate (cAMP)-mediated vWF secretion through a direct effect on endothelial cells. Overall, DDAVP is a useful tool for increasing von Willebrand factor levels in the body, allowing for safer and more successful surgical and dental procedures.

According to NICE guidance, the first-line treatment for a confirmed proximal deep vein thrombosis is a direct oral anticoagulant such as apixaban or rivaroxaban. When warfarin is used, an initial pro-coagulant state occurs, so heparin is needed for cover until the INR reaches the target therapeutic range and until day 5. Low-molecular-weight heparin is typically used with warfarin in the initial anticoagulation phase, but it can accumulate in patients with renal dysfunction. Unfractionated heparin infusion is used in these cases. For patients with normal or slightly deranged renal function, low-molecular-weight heparin can be given once per day as a subcutaneous preparation. However, warfarin is not the first-line treatment according to NICE guidance.

Diagnosis and Associated Risks of Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is diagnosed when there is evidence of at least two out of three features, with other potential causes excluded. These features include oligoamenorrhoea, elevated levels of total/free testosterone (or clinical features suggestive of hyperandrogenism), or the presence of polycystic ovaries on ultrasound. While an extremely marked elevation in testosterone can suggest an androgen-secreting tumor, this is rare. Additionally, raised luteinising hormone (LH) with a normal follicle-stimulating hormone (FSH) can lead to an elevated LH/FSH ratio, but this is not diagnostic.

PCOS is associated with an increased risk of impaired glucose tolerance, although this may take a number of years to become apparent. Furthermore, there may be a reduction in levels of oestriol, although this is not always a consistent finding. It is important to diagnose PCOS early on to manage the associated risks and prevent potential complications.

Using Biomarkers to Detect Premature Rupture of Membranes

Premature rupture of membranes (PROM) can be difficult to diagnose in some cases. In 2006, a study was conducted to determine if measuring certain biomarkers in vaginal fluid could be used as an indicator of membrane rupture. The study found that alpha-fetoprotein (AFP) had the highest accuracy in predicting PROM, with a specificity and sensitivity of 94%. This suggests that AFP could be used as a marker in cases where diagnosis is uncertain.

In addition to AFP, other biomarkers have been identified for different purposes. Carcinoembryonic antigen (CEA) is a tumor marker for colon cancer, while cancer antigen 125 (CA125) is a tumor marker for ovarian cancer. By measuring these biomarkers, doctors can detect the presence of cancer and monitor its progression. Overall, biomarkers have proven to be a valuable tool in diagnosing and monitoring various medical conditions.

Specialty Departments and Diagnosis of Coeliac Disease

The patient presents with microcytic, hypochromic anaemia, Howell-Jolly bodies, and splenic dysfunction, along with low albumin and calcium suggestive of malabsorption and emaciation. The most likely diagnosis is coeliac disease, which can be confirmed by antibody tests and a duodenal biopsy in the Gastroenterology department. Haematology can investigate the abnormal blood count, but treatment is not within their scope. Chronic kidney or liver disease is less likely, and there are no neurological symptoms.

Blood Film Abnormalities and Their Significance

Blood film abnormalities can provide important diagnostic information about a patient’s health. One such abnormality is Howell-Jolly bodies, which are nuclear remnants found in red blood cells and indicate hyposplenism. Other abnormalities seen in hyposplenism include target cells, Pappenheimer cells, increased red cell anisocytosis and poikilocytosis, and spherocytes. Patients with hyposplenism are at increased risk of bacterial infections and should be vaccinated accordingly.

Rouleaux formation, on the other hand, is a stack of red blood cells that stick together, forming a rouleau. This occurs in conditions where plasma protein is high, such as multiple myeloma, some infections, Waldenström’s macroglobulinemia, and some cancers.

Schistocytes are irregular and jagged fragments of red blood cells that occur due to mechanical destruction of red blood cells in conditions such as hemolytic anemia. They are not typically seen in hyposplenism.

Tear drop cells, which are seen in conditions where there is abnormality of bone marrow function, such as myelofibrosis, are also not seen in hyposplenism.

Finally, toxic granulation occurs during inflammatory processes such as bacterial infection or sepsis and refers to neutrophils which contain dark, coarse granules. It is not present in hyposplenism.

In summary, understanding blood film abnormalities and their significance can aid in the diagnosis and management of various medical conditions.

Common Causes of Transfusion Errors

Mislabelling of samples, requests, or misidentifying recipients are the most frequent causes of transfusion errors. This was confirmed by the SHOT study, which examined transfusion errors and near-misses in a nationwide audit in the United Kingdom. Although other errors, such as cross-match errors, incorrect storage, and transfusion reactions due to undetected antibodies, do occur, they are infrequent.

In summary, the SHOT study found that the most common causes of transfusion errors are related to labelling and identification. Therefore, it is crucial to implement strict protocols and procedures to ensure that samples and requests are correctly labelled and recipients are accurately identified to prevent these errors from occurring. While other errors may occur, they are rare and can be mitigated through proper training and adherence to established guidelines.

Donor safety is important in blood donation. Fainting is a common adverse event and should be treated by stopping the donation and reviving the donor. Elevation of the legs and monitoring vitals is necessary. Donors should be counseled on pre-donation expectations and encouraged to drink fluids after recovery. Hemoglobin checks are no longer required.

Management of Unexplained Microcytic Anemia with Low Ferritin

Unexplained microcytic anemia with low ferritin levels requires prompt investigation to identify the underlying cause. According to National Institute for Health and Care Excellence (NICE) guidelines, men with unexplained iron deficiency anemia and a hemoglobin level below 110 g/l should be urgently referred for upper and lower gastrointestinal investigations, regardless of age. A trial of oral iron may be appropriate in pregnant women or premenopausal women with a history of menorrhagia and without gastrointestinal symptoms or a family history of gastrointestinal cancer.

A faecal occult blood test is not recommended as it has poor sensitivity and specificity. Referral to haematology is not necessary as first-line investigations would be upper and lower gastrointestinal investigations, and thus a referral to gastroenterology would be warranted. It is important to rule out blood loss, in particular, through gastrointestinal investigations, before implicating poor dietary intake as the cause of the patient’s low iron stores and microcytic anemia.

Treatment and Prognosis of Acute Temporary Thrombocytopenic Purpura

Acute temporary thrombocytopenic purpura is a condition that often occurs after a viral infection. Fortunately, 85% of children with this condition will recover within a year. Platelet transfusions are not helpful unless there is active bleeding or surgery is necessary. Instead, treatment typically involves immune suppression with medications like prednisolone or intravenous immune globulin infusions. The clotting time remains normal because the coagulation factors are not affected. However, detecting antiplatelet antibodies can be challenging with many assays. While splenectomy may be an option in some cases, it is not recommended early in the disease as it may resolve on its own within a year. Overall, with proper treatment and monitoring, most children with acute temporary thrombocytopenic purpura can expect a positive outcome.

Megaloblastic Bone Marrow and Its Causes

A megaloblastic bone marrow is a condition that occurs due to a deficiency in vitamin B12 or folate, as well as some cytotoxic drugs. This condition is characterized by the presence of large, immature red blood cells in the bone marrow. However, other causes of macrocytosis, which is the presence of abnormally large red blood cells in the bloodstream, do not result in a megaloblastic bone marrow appearance. It is important to identify the underlying cause of macrocytosis to determine the appropriate treatment.

Management of Deep Vein Thrombosis and Pulmonary Embolism

Apixaban and rivaroxaban are the preferred medications for treating deep vein thrombosis (DVT), except for patients with renal impairment or antiphospholipid syndrome. Low molecular weight heparin (LMWH) and warfarin are alternative options for those who cannot take apixaban or rivaroxaban. Thrombolysis is used to manage pulmonary embolism (PE) in patients with haemodynamic instability.

The duration of anticoagulation treatment depends on the type of DVT. For provoked DVTs, which have an identifiable cause, treatment is recommended for at least three months. After this period, the risks and benefits of continuing anticoagulation treatment must be assessed to determine further treatment. For unprovoked DVTs, which have no identifiable cause, treatment is recommended for at least six months. After this period, a risk and benefit assessment is required to determine further treatment.

NICE has provided a helpful visual summary to assist in the management of DVT and PE.

Microcytic Hypochromic Anaemia and the Importance of Blood Transfusion

This patient is presenting with a microcytic hypochromic anaemia, which is commonly caused by iron deficiency due to occult gastrointestinal (GI) blood loss in a Caucasian population. To determine the cause of the anaemia, a full history and examination should be conducted to look for clues of GI blood loss. Given the microcytic hypochromic picture, it is likely that blood loss has been ongoing for some time.

Although there is no evidence of haemodynamic compromise or congestive cardiac failure (CCF), the patient is experiencing breathlessness on minimal exertion. This justifies an upfront transfusion to prevent the patient from going into obvious cardiorespiratory failure. At a Hb of 64 g/L in a 72-year-old, the benefits of transfusion outweigh the risks.

While haematinics such as ferritin, vitamin B12, and folate are important investigations, the most crucial management step is organising a blood transfusion. This will help to address the immediate issue of anaemia and prevent further complications.

Causes of Macrocytic and Microcytic Anaemia

Anaemia is a condition characterized by a decrease in the number of red blood cells or haemoglobin in the blood. Macrocytic anaemia is a type of anaemia where the red blood cells are larger than normal, while microcytic anaemia is a type where the red blood cells are smaller than normal. Here are some of the causes of macrocytic and microcytic anaemia:

Alcohol Excess: Alcohol toxicity can directly affect the bone marrow, leading to macrocytic anaemia. Additionally, alcoholism can cause poor nutrition and vitamin B12 deficiency, which can also lead to macrocytosis.

Congenital Sideroblastic Anaemia: This is a rare genetic disorder that produces ringed sideroblasts instead of normal erythrocytes, leading to microcytic anaemia.

Iron Deficiency: Iron deficiency is a common cause of anaemia, especially in women. However, it causes microcytic anaemia, not macrocytic anaemia.

Blood Loss from Menses: Chronic blood loss due to menorrhagia can result in microcytic iron deficiency anaemia. However, this is a physiological process and would not cause macrocytic anaemia.

Thalassemia: Thalassaemia is a genetic disorder that leads to abnormal or low haemoglobin, resulting in microcytic anaemia.

Treatment options for ITP patients

Intravenous immunoglobulin is the preferred treatment for patients with immune thrombocytopenia (ITP) who also have diabetes. Steroids may be used as a trial treatment if the patient does not have any contraindications for steroid-related complications. Platelets are not typically effective in raising platelet counts in ITP patients because they are destroyed by the antibodies. However, they may be used in emergency situations to treat major bleeding. It is important for healthcare providers to carefully consider the individual patient’s medical history and current condition when selecting a treatment plan for ITP. Proper treatment can help manage symptoms and improve quality of life for patients with this condition.

Understanding Different Causes of Haemolytic Anaemia

Haemolytic anaemia is a condition where red blood cells are destroyed faster than they can be produced, leading to a shortage of oxygen-carrying cells in the body. There are various causes of haemolytic anaemia, including phosphatidylinositol glycan A defect, vitamin B12 deficiency, glucose-6-phosphate dehydrogenase deficiency, loss of spectrin in the red blood cell membrane, and immunoglobulin M (IgM) antibody against red blood cells.

Phosphatidylinositol glycan A defect, also known as nocturnal haemoglobinuria, is an acquired condition caused by a mutation in the gene encoding for phosphatidylinositol glycan A. This leads to an increased susceptibility of red blood cells to complement proteins in an acidotic environment, resulting in haemolysis. Patients typically present with haematuria in the morning, and treatment involves managing symptoms and using medication such as eculizumab.

Vitamin B12 deficiency causes megaloblastic anaemia and is not related to haemolysis. Glucose-6-phosphate dehydrogenase deficiency is an inherited X-linked recessive condition that results in red blood cell breakdown. Loss of spectrin in the red blood cell membrane is seen in hereditary spherocytosis, where red blood cells become spherical and are trapped in the spleen, leading to haemolysis. IgM antibody against red blood cells causes autoimmune haemolytic anaemia, where the antibody binds to the I antigen on the membrane of red blood cells, leading to haemolysis at low temperatures.

Understanding the different causes of haemolytic anaemia is crucial for proper diagnosis and treatment.

Symptoms and Diagnosis of Hyperprolactinaemia

Hyperprolactinaemia is a condition characterized by elevated levels of prolactin in the body. This condition is typically associated with symptoms such as milk production, decreased libido, and absence of menstruation. However, visual disturbances are not always present, as many cases of hyperprolactinaemia are related to a microprolactinoma.

When diagnosing hyperprolactinaemia, it is important to assess thyroid status as this condition is often associated with hypothyroidism. Thyroxine levels are usually low in individuals with hyperprolactinaemia. Additionally, beta-HCG levels are elevated in pregnancy, so it is important to rule out pregnancy as a potential cause of elevated prolactin levels.

In summary, hyperprolactinaemia is a condition that can present with a variety of symptoms, but is typically characterized by elevated prolactin levels. Diagnosis involves assessing thyroid status and ruling out pregnancy as a potential cause.

Diagnosis of Beta Thalassaemia

Beta thalassaemia can be diagnosed through the presence of mild microcytic anaemia, target cells on the peripheral blood smear, and a normal red blood cell count. However, the diagnosis is confirmed through the elevation of Hb A2, which is demonstrated by electrophoresis. In beta thalassaemia patients, the Hb A2 level is typically around 4-6%.

It is important to note that in rare cases where there is severe iron deficiency, the increased Hb A2 level may not be observed. However, it becomes evident with iron repletion. Additionally, patients with the rare delta-beta thalassaemia trait do not exhibit an increased Hb A2 level.

In summary, the diagnosis of beta thalassaemia can be suggested through certain symptoms and blood tests, but it is confirmed through the measurement of Hb A2 levels.

Tumor Markers and Their Association with Different Cancers

Tumor markers are substances that are produced by cancer cells or by normal cells in response to cancer. These markers can be used to detect the presence of cancer, monitor the progress of treatment, and detect the recurrence of cancer. One such tumor marker is CA125, which is associated with ovarian carcinoma. However, elevations in CA125 can also be seen in uterine cancer, pancreas, stomach, and colonic tumors. In some cases, benign ovarian tumors can also cause a rise in CA125 levels. If a patient has a CA125 level of over 200U/ml and an abnormal ultrasound scan, it is highly likely that they have ovarian carcinoma.

Other tumor markers include CA19-9, which is primarily associated with pancreatic tumors, beta-HCG, which is associated with germ cell tumors, alpha-fetoprotein, which is associated with hepatocellular carcinoma, and carcinoembryonic antigen, which is associated with colonic carcinoma. While AFP and beta-HCG can rarely be secreted by ovarian tumors, it is important to check CA125 levels first, as they are much more frequently elevated. By monitoring tumor markers, doctors can detect cancer early and provide appropriate treatment.

Leukoerythroblastic Reactions and Myelofibrosis

Leukoerythroblastic reactions refer to a condition where the peripheral blood contains immature white cells and nucleated red cells, regardless of the total white cell count. This means that even if the overall white cell count is normal, the presence of immature white cells and nucleated red cells can indicate a leukoerythroblastic reaction. Additionally, circulating blasts may also be seen in this condition.

On the other hand, myelofibrosis is characterized by the presence of tear drop cells. These cells are not typically seen in other conditions and are therefore considered a hallmark of myelofibrosis. Tear drop cells are red blood cells that have been distorted due to the presence of fibrous tissue in the bone marrow. This condition can lead to anemia, fatigue, and other symptoms.

Overall, both leukoerythroblastic reactions and myelofibrosis are conditions that can be identified through specific characteristics in the peripheral blood. It is important for healthcare professionals to be aware of these findings in order to properly diagnose and treat patients.

Treatment Options for a Patient with Sickle Cell Disease and Acute Chest Pain Crisis

A patient with sickle cell disease is experiencing an acute chest pain crisis, likely due to a lower respiratory tract infection. Hydroxycarbamide is recommended as a preventative therapy to reduce the risk of future crises by increasing the amount of fetal hemoglobin and reducing the percentage of red cells with hemoglobin S. Granulocyte colony-stimulating factor (G-CSF) is not necessary as the patient has a raised white blood cell count. Inhaled beclomethasone is not appropriate as asthma or COPD are not likely diagnoses in this case. Oral prednisolone may be used as a preventative therapy for severe asthma, but is not recommended for COPD and is not appropriate for this patient’s symptoms. A tuberculosis (TB) vaccination may be considered for primary prevention, but would not be useful for someone who has already been infected.

Important Points to Remember about Fetomaternal Haemorrhage

Following the delivery of a baby, it is crucial to determine the degree of fetomaternal haemorrhage (FMH) in a D negative mother. This is done by analyzing a blood sample to adjust the dose of anti-D in the mother if she has delivered a D positive child. It is important to note that D positive and D negative women have the same likelihood of developing antibodies to other red cell antigens. Therefore, all pregnant women should undergo a blood group and antibody screen in their first trimester or at the time of presentation, whichever comes first. The fetal Rh type is determined by the Rh typing of both the mother and father. Additionally, maternal antibody titres are indicative of the degree of haemolytic disease of the newborn (HDN). For more information on the management of women with red cell antibodies during pregnancy, refer to the Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline No. 65.

Pathophysiological Mechanisms of Various Medical Conditions

Haemophilia: Deficiency of a Clotting Factor in the Intrinsic Pathway of Coagulation
Haemophilia is an X-linked recessive condition that affects the intrinsic pathway of coagulation. It is caused by a mutation in factor VIII or IX, leading to deficient coagulation. Patients present with excessive bleeding, such as spontaneous bruising, prolonged bleeding following a dental procedure or minor injury, bleeding into the joints (haemarthrosis), and epistaxis. Treatment involves correcting the deficiency with concentrated factor VIII or IX.

Von Willebrand’s Disease: Deficiency of a Protein Found in Endothelial Cells and Released by Endothelial Damage
Von Willebrand’s disease is an autosomal dominant, inherited bleeding disorder caused by a deficiency of the von Willebrand factor. This protein is found in the endothelial cells lining the vessels and is released following endothelial damage. It promotes adhesion of platelets to the area of damage and stabilizes factor VIII, both actions promoting haemostasis. Symptoms include easy bruising and prolonged bleeding following minimal trauma.

Ewing’s Sarcoma: Translocation Between Chromosomes 11 and 22
Ewing’s sarcoma is a malignant bone tumour seen in children and young adults. It is caused by a translocation between chromosomes 11 and 22.

Leukaemia: Invasion of Bone Marrow by Leukaemic Cells
Leukaemia is a type of cancer that affects the blood and bone marrow. It is caused by the invasion of bone marrow by leukaemic cells, leading to pancytopenia, a condition in which there is a deficiency of all three types of blood cells: red blood cells, white blood cells, and platelets. Symptoms include fatigue, weakness, shortness of breath, and increased susceptibility to infections. Treatment involves chemotherapy, radiation therapy, and bone marrow transplantation.

Infective Risks of Blood Transfusion

Blood transfusions carry the risk of transmitting viral infections such as hepatitis B, hepatitis C, and HIV. The likelihood of infection varies depending on the source of the donation and the type of testing used. In the UK, the risk of contracting hepatitis B from a blood transfusion is approximately 1 in 1.3 million donations. The risks for HIV and hepatitis C are even lower, at 1 in 6.5 million and 1 in 28 million donations, respectively. It is important for healthcare professionals to have a comprehensive of these risks when obtaining consent from patients for blood transfusions. Adequate knowledge and communication can help patients make informed decisions about their healthcare.

Treatment Options for Pernicious Anemia with Hydroxocobalamin

Pernicious anemia is a type of anemia caused by a deficiency in vitamin B12, often due to the presence of anti-intrinsic factor antibodies. Hydroxocobalamin is a form of vitamin B12 that can be used for supplementation in patients with pernicious anemia. Here are some treatment options with hydroxocobalamin:

1. Hydroxocobalamin 1 mg IM three times a week for two weeks, then 1 mg IM every three months: This is the standard dose for patients with pernicious anemia without neurological deficits.

2. Hydroxocobalamin 1 mg IM on alternate days indefinitely: This is used for patients with pernicious anemia and neurological involvement until symptom improvement reaches a plateau, then maintenance involves 1 mg IM every two months.

3. Hydroxocobalamin 1 mg IV three times a week for two weeks, then monthly: This is used for the treatment of cyanide poisoning, not for pernicious anemia.

4. Hydroxocobalamin 1 mg IM three times a week for two weeks, then oral 1 mg hydroxocobalamin: Oral supplementation is not appropriate for patients with pernicious anemia due to absorption issues.

5. Hydroxocobalamin 1 mg subcutaneously three times a week for two weeks, monthly for three months, then 3-monthly: Hydroxocobalamin is administered IM, not subcutaneously.

In conclusion, hydroxocobalamin is an effective treatment option for pernicious anemia, but the dosage and administration route should be carefully considered based on the patient’s individual needs.

The patient is presenting with thrombotic thrombocytopenic purpura (TTP), which is characterized by low platelet count due to clotting and platelet sequestration in small vessels. TTP is associated with haemolytic anaemia, thrombocytopenic purpura, fever, and neurological and renal abnormalities. The patient’s risk factors for TTP include being female, obese, pregnant, and of Afro-Caribbean origin. To determine the appropriate management, a urinary β-hCG test should be performed to establish pregnancy status. The first-line treatment for TTP is plasma exchange with fresh frozen plasma. Blood cultures should also be performed to check for underlying septicaemia. Antiplatelet antibody titres can be raised in idiopathic thrombocytopenic purpura (ITP), but ITP does not cause renal failure. A bone marrow study is appropriate to rule out leukaemia. Illicit drug use should also be considered as a cause of disseminated intravascular coagulation (DIC).