Internal Medicine Cases

Her peripheral blood smear

Differential diagnosis for thrombocytopenia in pregnancy and their common features

Case number 23 A 30-year-old PREGNANT woman (G2P1L1Ab0) in her 6th GW came to obstetrics emergency after she realized that she has thrombocytopenia in her regular laboratory check-up. She admits no episodes of bleeding or skin ecchymosis, no headache or blurred vision. She confirms that she had normal plt count 3 weeks before conception. She also has hashimoto thyroiditis and is using levothyroxine 100 micro daily. Oh physical examination there was no sign of bleeding and no neurological abnormality. Her CBC WBC 7700 Hb 12.1 Plt 25000 Vaginal sonography reveals a 4 × 8 mm subchorionic hematoma. No other abnormality was reported.

Thrombolytic dosage and administration

How to use anticoagulant during fibrinolysis

PTE factors indicating poor prognosis

Thrombolytic therapy contraindications

Thrombolytic therapy indication in PTE

Share share_-793885607.png Pulmonary embolism severity index (PESI) Score

Common ECG findings in PTE (the most common finding is sinus tachycardia)

Wells criteria for diagnosis of pulmonary embolism

Because of sudden onset dyspnea, tachycardia, low SPO2, and hypotension, and ECG changes in favor of PTE and RV dilation (sinus tachycardia, S1Q3T3 sign and T wave inversion in leads V1-V4) pulmonary thromboembolism was the most probable diagnosis. So intravenous anticoagulant (unfractionated heparin) started ASAP and the patient was sent for pulmonary CT angiogram thereafter.

Her ECG

Case number 22 A 53-year-old woman comes to the emergency ward with the complaint of dyspnea and drowsiness from 6 hours ago. She is a known case of breast cancer from 10 months ago who did not follow chemotherapy since 2 months ago. She has orthopnea and fever. She is drowsy but wakes up by calling. BP= 80/60 PR= 130/min T= 37.9 SPO2= 88% room air Lab tests: WBC = 10000 Hb = 8.6 Plt = 230000 INR = 1.06 PTT = 25 Troponin negative LDH 950