Blood & Lymphoreticular System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M58_F1.jpg"}},{"insert":"\n\n"},{"insert":"Feeling relieved that a long day at the hematology-oncology clinic is nearly over, you gather up your bike helmet and prepare for the refreshing ride home.\n\nThe phone rings. Dr. Osborne from the emergency room is on the other end. \u0022We have a patient with vaginal bleeding who seems to be having a coagulopathy. Would you mind taking a look?\u0022\n\nYou agree and make your way there. You are introduced to 35-year-old Shilpa, and her husband, Mr. Singh.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M58_F2.jpg"}},{"insert":"\n\n"},{"insert":"Shilpa is a G2P0 who is currently at 19 weeks + 5 days of gestation. Her pregnancy has been regularly followed-up by the obstetrician at your hospital and has been uneventful thus far.\n\nShe experienced several episodes of vaginal bleeding over the last 48 hours. The blood was bright red in color, odorless and had \u0022soaked an entire pad\u0022. The episodes were not related to coitus, exertion or trauma. She has not had any pelvic pain or cramps.\n\nDuring the preceding week, Shilpa noticed two large unexplained bruises over her back and thigh respectively. She also had three episodes of gingival bleeding after brushing her teeth and a spontaneous nosebleed.\n\nHer medical history is unremarkable. The last gestational ultrasound was 10 days ago and confirmed a normally developing singleton fetus. The placenta was normal in appearance and located on the posterior uterine wall.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M58_F6.jpg"}},{"insert":"\n\n"},{"insert":"Dr. Osborne\u0027s examination notes specify that her vital signs are stable. The uterus was soft and nontender, with a fundal height compatible with the age of gestation. Speculum examination showed a closed cervix with no active bleeding. The fetal heart rate (FHR) was 140 bpm.\n\nYou perform your own examination, focusing on hematological manifestations. During this, you note mild conjunctival pallor and two ecchymoses over the back. No other untoward physical findings are present.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M58_F2.jpg"}},{"insert":"\n\n"},{"insert":"Finishing off the examination, you step back and ponder the possibilities.\n\nWhat are you thinking of?\n"}]}
1. A platelet disorder
2. A coagulation disorder
3. A vascular disorder