hemolytic anemia/hemolytic uremic syndrome

See Explanation

[]

Question 1 / 4

683ba6ed31242d93219d30b2

Hematology

hemolytic anemia

hemolytic uremic syndrome

Case History

A 32-year-old woman presents to an urgent care clinic with a 5-day history of worsening fatigue, dark urine, and diffuse abdominal discomfort, which started after a diarrheal illness characterized by severe, bloody stools. She reports decreased urine output over the past 24 hours. Her medical history is otherwise unremarkable. On examination, she appears pale and jaundiced. Vital signs reveal a blood pressure of 90/55 mm Hg, pulse rate of 115/min, respiratory rate of 18/min, and temperature of 37.2 °C. Abdominal palpation elicits diffuse tenderness but no guarding or rebound. Petechiae are noted on her lower extremities. The rest of her physical examination is non-contributory. Laboratory findings are now available: The peripheral blood smear shows schistocytes and scant platelets without clumps. The direct antiglobulin (Coombs) test is negative. Given her presentation, what is the most likely diagnosis and the appropriate immediate management strategy?

Lab Parameter	Value	Reference Range
Haptoglobin	Undetectable	0.3-2.0 g/L
Hemoglobin	61 g/L	125-170 g/L
Leukocyte count	6.8 x 10^9/L	3.5-10.5 x 10^9/L
Platelet count	37 x 10^9/L	130-380 x 10^9/L
Reticulocytes	9.8%	0.5-1.5%
Creatinine	318 µmol/L	70-120 µmol/L
Blood Urea Nitrogen (BUN)	25 mmol/L	2.5-7.5 mmol/L
Potassium	5.8 mmol/L	3.5-5.0 mmol/L
Urinalysis Blood	3+
Urinalysis Protein	3+
Urinalysis Microscopic examination	several granular casts

A ) Hemolytic Uremic Syndrome and aggressive intravenous fluid resuscitation with close monitoring of renal function, anticipating potential need for renal replacement therapy.

B ) Atypical Hemolytic Uremic Syndrome and immediate initiation of eculizumab therapy.

C ) Thrombotic Thrombocytopenic Purpura and urgent plasma exchange.

D ) Disseminated Intravascular Coagulation and broad-spectrum antibiotics with aggressive crystalloid infusion.

Edit question

See Explanation

[]

Question 2 / 4

683ba6ed31242d93219d31b7

Hematology

hemolytic anemia

hemolytic uremic syndrome

Case History

A 26-year-old man is admitted to the general internal medicine service with a 3-day history of escalating bloody diarrhea, severe abdominal cramping, and recent onset of oliguria. He recently returned from a wilderness hiking trip where he consumed untreated stream water and admits to consuming various undercooked game meats. His vital signs upon arrival are notable for a temperature of 36.80C, blood pressure of 102/55 mmHg, pulse of 130 beats/min, respirations of 14/min, and oxygen saturation of 98% on room air. Physical examination reveals generalized pallor, diffuse mild abdominal tenderness without rebound or guarding, and diminished bowel sounds. He appears lethargic. Initial laboratory studies were ordered.

Lab Parameter	Value	Reference Range
Hemoglobin	92 g/L	130-170 g/L
Hematocrit	0.29	0.40-0.54
Leukocyte count	9.5 x 10^9/L	4.0-11.0 x 10^9/L
Platelet count	87 x 10^9/L	150-450 x 10^9/L
Lactate dehydrogenase (LDH)	327 U/L	140-280 U/L
Haptoglobin	0.05 g/L	0.4-2.0 g/L
Sodium	139 mmol/L	135-145 mmol/L
Chloride	100 mmol/L	98-107 mmol/L
Potassium	5.9 mmol/L	3.5-5.0 mmol/L
Bicarbonate	19 mmol/L	22-29 mmol/L
Blood urea nitrogen (BUN)	21.1 mmol/L	2.9-7.1 mmol/L
Glucose	5.5 mmol/L	3.9-6.1 mmol/L
Creatinine	97.2 micromol/L	62-106 micromol/L
Calcium	2.55 mmol/L	2.10-2.55 mmol/L
Peripheral blood smear	Schistocytes observed	None
Urinalysis	Positive for protein and red blood cells	Negative for protein and red blood cells

A ) Campylobacter jejuni enteritis with empiric azithromycin and aggressive rehydration

B ) Colon adenocarcinoma with urgent surgical consultation and blood product transfusion

C ) Entamoeba histolytica colitis with empiric metronidazole and volume expansion

D ) Escherichia coli O157:H7 infection with aggressive fluid resuscitation, close monitoring for renal failure, and avoidance of antibiotics

E ) Giardia lamblia infection with stool parasite examination and initiation of nitazoxanide

Edit question

See Explanation

[]

Question 3 / 4

683ba6ed31242d93219d31b5

Hematology

hemolytic anemia

hemolytic uremic syndrome

Case History

A 9-year-old girl is brought to the pediatric emergency department with a 5-day history of progressively worsening diarrhea, initially non-bloody but now with streaks of blood, which started after attending a community picnic. She has become increasingly lethargic, weak, and has had decreased urine output over the last 24 hours. Her vital signs include: T 38.2 C, HR 128 beats/min, BP 88/58 mmHg. On physical examination, she appears pale and listless. Petechiae are noted on her lower extremities, and she exhibits diffuse abdominal tenderness to light palpation without rebound guarding. Laboratory results are pending, but initial point-of-care testing confirms acute kidney injury and significant thrombocytopenia. What is the most appropriate initial management strategy for this patient and what acute complication should be most closely monitored?

Lab Parameter	Value	Reference Range
Blood Urea Nitrogen (BUN)	26.5 mmol/L	2.5-7.1 mmol/L
Creatinine	750 µmol/L	26-62 µmol/L
Platelet Count	8 x 10^9/L	150-450 x 10^9/L
Hemoglobin	68 g/L	115-135 g/L
Lactate Dehydrogenase (LDH)	1350 U/L	140-280 U/L
Haptoglobin	<0.1 g/L	0.3-2.0 g/L
Direct Coombs Test	Negative	Negative

A ) Initiate broad-spectrum intravenous antibiotics and monitor for colonic perforation.

B ) Aggressive intravenous fluid resuscitation and close monitoring for severe electrolyte derangements.

C ) Careful fluid balance, red blood cell transfusion as needed, and monitoring for fluid overload and progression to renal failure requiring dialysis.

D ) Begin plasma exchange therapy and vigilance for neurological complications.

E ) Administer corticosteroids and assess for severe gastrointestinal bleeding.

Edit question

See Explanation

[ "https://i.postimg.cc/PJ9dGJvB/case-107021-image-1-screen-shot-2014-09-30-at-11-02-49-pm.jpg" ]

Question 4 / 4

683ba6ed31242d93219d31b6

Hematology

hemolytic anemia

hemolytic uremic syndrome

Case History

A 6-year-old female is admitted to the pediatric inpatient unit after presenting to the emergency department with a 5-day history of progressively worsening severe abdominal pain and bloody diarrhea, followed by vomiting for the last 48 hours. Her parents recall she attended a community picnic approximately 8 days prior. On admission, her vital signs are: T 38.5 C, HR 122 bpm, BP 105/70 mmHg, SpO2 99% on room air. Physical examination reveals diffuse abdominal tenderness, but no guarding or rebound. She appears pale and lethargic. Peripheral blood smear analysis confirms the presence of fragmented red blood cells (schistocytes). Given these findings, what is the most appropriate initial management strategy for this patient, and what critical complication should be closely monitored?

Lab Parameter	Value	Reference Range
White Blood Cell Count	9.0 x 10^9/L	4.0-11.0 x 10^9/L
Hemoglobin	102 g/L	115-135 g/L (age 6)
Hematocrit	0.33	0.34-0.40
Platelet Count	46 x 10^9/L	150-450 x 10^9/L
Creatinine	115 µmol/L	26-62 µmol/L (age 6)
Lactate Dehydrogenase (LDH)	850 U/L	< 250 U/L
Total Bilirubin	35 µmol/L	< 21 µmol/L
Potassium	5.8 mmol/L	3.5-5.0 mmol/L
Sodium	130 mmol/L	135-145 mmol/L

A ) Aggressive intravenous antibiotic administration and early plasmapheresis initiation.

B ) Strict fluid restriction and immediate preparation for peritoneal dialysis.

C ) Supportive care with meticulous fluid and electrolyte management, and close monitoring for acute kidney injury.

D ) High-dose corticosteroid therapy and urgent surgical evaluation for acute abdomen.

E ) Platelet transfusions to correct thrombocytopenia and empiric anticoagulation therapy.

Edit question