PBL Sessions: Hematology Organ System - 2


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Page 5

History of Present Illness:

She receives anticonvulsant medications and is started on dexamethasone, 4 mg q.i.d.

Additional laboratory studies include: prothrombin time 12.3 seconds (control 12 sec), partial thromboplastin time 27 seconds (control 26 sec), serum haptoglobin 6 mg/dL, direct Coombs test negative, and indirect Coombs test negative. Her serum ferritin is 6 ng/mL. Urinalysis shows pH 6, sp gr 1.018, glucose negative, protein negative, ketones 1+, blood 2+, and leukocyte esterase negative. Urine microscopic examination shows renal tubular epithelial cells with hemosiderin.

She is initially started on intravenous heparin, which is continued for 2 weeks, and then she is started on coumadin that is continued. After 2 weeks of coumadin therapy her prothrombin time is 24 seconds with INR of 2.

Tasks

  • What do these findings indicate?

  • What hypotheses explain these findings?

  • Explain your reasoning for the hypotheses you choose.

  • Is there anything that can tie these findings together?

Stop !! Complete discussions and tasks before moving to the next page.