Case 84 – update 1

So we have an update:

We have found our patient is thrombocytopenic, and has a mild normocytic anaemia.

Our patient has been slightly tired for a year or so, but still manages to do her demanding job as a PE teacher. She has no past medical history and is on no regular medication

The patient does notice she is bruising easily but does not have any bleeding problems. A bleeding score is 1 (isth-ssc), and our patient says her job can be quite physical, so put it down to that. She denies any night sweats/weight loss. There is no parental history of bleeding problems. Our patient’s father was born in Israel and moved to England when he was 2, our patient’s mother was born in the England.

On examination:

  • Chest clear
  • HS I+II+O
  • Abdo soft, the spleen can just be felt below the costal margin
  • There are no rashes.
  • The patient has a few cutaneous bruising on arms and shins, none >2cm, no palpable haematomas.

We have done a number of blood tests:

  • Blood film – thrombocytopenia, but morpholocicaly normal red/white cells/platelets. No plt clumps.
  • B12/fol normal
  • U+E – normal
  • LFT – normal
  • Auto immune screen including RH factor, ANA, ENA,ANCA negative
  • Coag
    • PT 13.4
    • APTT 33
    • CLAUS FIB 3.7
    • VWD screen, factor XIII, PFA-100 normal
  • HIV/hep B/hep C negative
  • EBV IgG positive, IgM negative
  • CMV IgG and IgM negative
  • An ultrasound abdo has been done and shows splenomegaly with a 16.5 cm spleen. Liver appears normal. Renal tract normal.

Questions:

  • What are your thoughts now?
  • Is there anything else you would like to know?
  • What should we do next?

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