I think we’re all in agreement that we currently can’t give a definitive diagnosis as is frequently the case in complex critically unwell individuals. From your responses the most likely differentials for our patient’s bi-cytopenias include the following (or combination of the following):
- Severe sepsis / critical illness (marrow suppression, consumptive coagulopathy, liver dysfunction etc)
- Drug induced immune mediated thrombocytopenia
- Post transfusion purpura
Hb 74 Plts 25 WCC 6 PT 20 APTT 41 Clauss fib 3
- How would you manage our patient generally and also if planned for further surgery (laparotomy)
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