Immune
Immune System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M10_F1.jpg"}},{"insert":"\n\n"},{"insert":"\u0022You know, we might as well be vampires,\u0022 your colleague says, munching on a potato chip. The two of you are relaxing in the doctors\u0027 lounge, watching the latest soap opera, just before the start of yet another shift.\n\n\u0022Why do you say that?\u0022 you ask lazily, while leaning over to grab another chip.\n\n\u0022Well, think about it. We have access to all the blood we could want, we look pale and sickly from eating all that cafeteria food, and I can\u0027t remember the last time I saw daylight.\u0022\n\n\u0022You know, you actually might have a point there,\u0022 you say. \u0022Although we\u0027d probably be dead by now, if we were vampires. These chips are garlic flavored.\u0022\n\nYou both laugh out loud. A second later, your pager lights up. You\u0027ve got a patient.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M10_F3.jpg"}},{"insert":"\n\n"},{"insert":"Paula Lopez awaits you in the clinic, along with her mother. She is 21 years old and in the 28th week of gestation of her first pregnancy.\n\nPaula has experienced several episodes of mild, painless vaginal bleeding over the past two days, although she is not bleeding right now. There were no associated cramps or contractions.\n\nA few hours ago, she experienced a nosebleed, which stopped after she pinched her nose and applied an ice-pack. Her mother was highly alarmed and rushed her over to the family doctor, who recommended that they see you as soon as possible.\n\nAt this point, her mother, Mrs. Lopez, jumps in and states that she has also noticed purplish bruising on Paula\u0027s ankles as well as her shins.\n\nPaula denies knowledge of any significant past medical history, family history or previous episodes of major bleeding. You also notice that she has an appointment scheduled with her obstetrician tomorrow.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M10_F5.jpg"}},{"insert":"\n\n"},{"insert":"On examination, Paula has a pulse of 88 bpm, blood pressure of 110\/82 mmHg and a respiratory rate of 22 cycles\/min. She is afebrile and anicteric. No lymph nodes are palpable. You note petechiae over both ankles.\n\nExamination of the abdomen reveals a fundal height compatible with the gestational age. There are no areas of tenderness and no organomegaly. The pelvic examination reveals no abnormalities. There is no active vaginal bleeding.\n\nYou decide to order several basic investigations. The results are as follows:\n\nWBC count: 10,800\/mm3 (4,000-10,000)\nDifferential WBC count:\r\n Neutrophils: 6,500\/mm3 (3,000-7,000)\n Lymphocytes: 3,500\/mm3 (1,000-4,000)\n Eosinophils: 200\/mm3 (50-400)\n Basophils: 100\/mm3 (25-200)\n Monocytes: 500\/mm3 (100-600)\nHb: 11.9 g\/dL (10.5-17.5)\r\nHct: 32.4% \r\nPlatelets: 16,000\/mm3 (150,000-400,000)\n\nBlood Group: A negative.\n\nINR: 1.02 (0.9-1.1)\r\nPT: 11.8 sec (10-14)\r\nAPTT: 38 sec (36-42)\n\nUrinalysis: no red blood cells, pus cells, or cell casts.\n"}]}
3
{"ops":[{"insert":"What will you do now?\n"}]}
1. Reassure Paula and ask her to take this up with her obstetrician tomorrow, at her scheduled visit
2. Admit Paula to your ward and in parallel, inform her obstetrician
3. Refer Paula to the emergency room immediately and in parallel, inform her obstetrician
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