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Washington University Experience | VASCULAR | Thrombotic Thrombocytopenic Purpura (TTP) | 4A0 Case 4 History
Case 4 History ---- The patient was a 56 year old female with a history of polyarthritis (and a purported “lupus like syndrome”), GERD, hypertension, anemia, and chronic renal insufficiency (baseline Cr = 1.8) was admitted on 9/22 for complaints of 1 week of fatigue, nausea, anorexia, and lightheadedness. Her laboratory workup showed a severe autoimmune hemolytic anemia with thrombocytopenia (hematocrit of 13.0, reticulocyte count of 18.9, and platelet count of 8K). She had an extensive workup during her brief admission and was diagnosed with Evans syndrome (autoimmune hemolytic anemia and immune thrombocytopenic purpura). In addition, she was found to fit the criteria for SLE, a first time diagnosis for her. Her ANA was 1:640 with a normal dsDNA. On 9/25, the evening prior to her death, the patient first began to experience confusion. A head CT was ordered which showed a 5 mm focus of hemorrhage in the left genu of the corpus callosum. An MRI was ordered to further evaluate this; this showed multiple punctate areas of hemorrhage within both cerebral hemispheres and the brain stem. She was found unresponsive on 9/26 and, despite aggressive resuscitation efforts, she expired on 9/26.
