A patient in the intensive care unit has anemia, schistocytes, ...

[geodog55]

A patient in the intensive care unit has anemia, schistocytes, and thrombocytopenia. The PT and PTT are elevated, and the fibrinogen is low. What test to confirm what diagnosis would be appropriate?
 
  a. D dimer to confirm acute DIC
  b. Bone marrow to confirm immune thrombocytopenic purpura
  c. Platelet antibody against P1A1 to confirm heparin-induced thrombocytopenia
  d. Platelet aggregometry to confirm posttransfusion purpura

Question 2

A 4-year-old child becomes very sick after eating undercooked ground beef. Kidney function tests are very elevated. Thrombocytopenia is mild, and a few schistocytes are noted on the blood film. Which of the following is most likely diagnosis?
 
  a. Immune thrombocytopenic purpura
  b. Thrombotic thrombocytopenic purpura
  c. Hemolytic uremic syndrome
  d. DIC

[Amiracle]

Answer to Question 1

ANS: A
In acute DIC, the D dimer is elevated, along with the other laboratory findings listed. None of the other conditions listed have the prolonged PT and PTT, low fibrinogen, and elevated D dimers.

Answer to Question 2

ANS: C
Hemolytic uremic syndrome is found primarily in children between the ages of 6 months to 4 years. About 90 of the cases are caused by Shigella dysenteriae serotypes or enterohemorrhagic Escherichia coli OH serotypes, particularly O157:H7. Hyaline thrombi form in the renal vasculature, leading to renal failure, thrombocytopenia, and a microangiopathic hemolytic anemia with some red cell fragmentation.