Case 128 – Update 1!

Thank you for everyone’s contributions so far!

Below is the additional information you requested to help determine the cause of our 65 year old patients anaemia and marked thrombocytopenia.

  • Her severe pancreatitis is secondary to gallstones.
  • She has a previous history of cholecystitis (due to gallstones) and well controlled hypertension.
  • She has no significant alcohol history.
  • She has been on amlodipine for years and takes no other medications or OTC treatments. She has however been on multiple new medications this admission including starting prophylactic low molecular weight heparin throughout admission and co-trimoxazole started approximately 5 days ago.
  • A CT abdo-pelvis this admission has demonstrated pancreatitis with marked necrosis, cholecystitis. The liver and spleen appear normal. Low volume lymphadenopathy (~2cm) in the porta hepatis but nil elsewhere.

 

Her bloods from this morning are as follows:

  • Hb 71 (several transfusions required throughout this admission)
  • Plts 20 (plt count was within normal range upto 3 days ago)
  • PT 19, APTT 40, Clauss fib 5.2
  • DAT negative. LDH 326
  • Stage 2 AKI, bilirubin 84 (ULN 21), ALT 250 (0-40), Alk phos normal
  • Blood film, retics, serum electropheresis, autoimmune screen, viral screen all pending

With this new information what are your differential diagnoses?

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