Case 11 – update 4

More info on case:

HIV, auto antibody screen, immunoglobulins, Hep B/C, lupus anticoagulant, anti-cardiolipin antibodies and TSH all normal.  A pregnancy test is negative.

The trip to the Caribbean was three months ago and she stayed in the Bahamas and did not leave the hotel resort.  There have been no fevers or other symptoms of malaria.  Prophylaxis was not taken.

She is not keen on a marrow biopsy as a friend had one and said it was painful.  As she has no other adverse features and has an otherwise normal film and no organomegaly/lymphadenopathy.  It is decided that she will have a trial of steroids and if no improvement then will need a marrow biopsy.

She is deemed fit to be discharged and has a prescription for prednisolone: 60mg (1mg/kg) with a PPI.  200mg iron sulphate TDS is also supplied.  A review is made for one week and advice card given along with leaflet and open access to the haematology ward.

She returns next week and her blood count has improved:

  • Hb 104g/L
  • MCV 76fL
  • WCC 14.9×10*9/L
  • Platelet 76×10*9/L

Questions

  • How would this approach differ if she were a child
  • Do you ask to avoid risky activity when the platelet count may fluctuate?

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

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Online education and discussion about all things haematological
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