Group Case Study 4

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					                                  Group Case Study 4

Ms, Chang, a 35-year-old woman, was seen by her physician. She complained of
weakness, low grade fever, periods of forgetfulness, and memory loss for the last week or
so. She denied any viral or bacterial illness prior to the onset of symptoms. She was on
oral contraceptives but was not taking any other drugs. Her initial laboratory tests

A CBC was ordered on the patient and the results were:

WBC:        8.9 x 109/L
Hemoglobin: 6.0 g/dL
Hct:        0.18 L/L

Consider what additional testing may be helpful in identifying the cause of the anemia.

Ms. Chang’s peripheral smear showed moderate schistocytes and polychromasia.

   1. What are some conditions that result in the presence of schistocytes?

As Ms. Chang was questioned further, she indicated that she noticed a large number of
bruises on her extremities. Her platlet count was 31 x109/L. She has a 2.5% reticulocyte

   2. What is the significance of these results?

   3. Why might the physician order coagulation tests?

Ms. Chang’s coagulation results were only slightly prolonged. The fibrinogen levels
were slightly decreased.

   4. What do these findings indicate about the underlying problem?

The patient’s symptoms continued to become even worse with frequent seizures,
headaches, and dizziness. Her urinalysis results showed a 2+ protein and moderate
blood. However, she had normal urinary volume.

   5. Based on these results, what is the most likely condition associated with these
      clinical and laboratory results? Explain.

   6. What therapy might be used?

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