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Culture Documents
Hgb 9.5
MCV 64
Platelets 530
Ca investigatii solicitati?
Hemoleucograma
Reticulocite
LDH
Haptoglobina
Frotiu periferic
Ce analize cereti in
plus:
test Koller
test Coombs direct si
indirect
test Schilling
Diagnostic final?
Patient Value
WBC
2.6 x 109/L
3.8 - 10.6
Hemoglobin
2.7 g/dL
12.9 -16.9
Hematocrit
7.7%
38.0 - 48.8
MCV
129.7 fL
82.6 - 97.4
RDW
46.7%
11.8 - 15.2
PLT
48 x 109/L
156 369
Reticulocyte
s
9.2%
0.8 2.0
Abs Retic
0.052 x 1012/L
0.018 0.158
LDH
6338 IU/L
<170
TBILI
8.8 mg/dL
0.3 1.5
DBILI
<0.1
Iron
159 g/dL
65 165
Saturation
64%
25 50%
TIBC
247 g/dL
250 420
Ferritin
135 ng/mL
10 282
B12
63 pg/mL
211 911
Folate
13.2 ng/mL
>5.4
Pacient, 32 ani,
consumator de etanol,
se prezinta pt astenie
progresiva, dispnee,
instalate in ultimele 3
luni
Fara istoric de infectii
sau sangerari
Rezectie intestinala
extinsa in antecedente
megaloblastica
macrocitara nonmegaloblastica
hemolitica autoimuna
aplastica cu pancitopenie
Septicemie
CID
Insuficienta hepatica
Fibrinoliza primara
PLT 40 -> 20
aPTT:
D-dimeri:
Fibrinogen:
62.8 (21-35)
>2000 ()
96 (150-450)
Analize utile:
TS
Factor VIII activitate
vWF antigen
vWF activitate ristocetina
vWF analiza multimeri
aPTT
Test Rumpell-Leed
TS prelungit
Agregarea la ristocetina normala, scazuta la epinefrina, colagen,
adenozina
Agregare la ristocetina scazuta, corectata de administrarea de plasma
proaspata
Trombocite gigant pe frotiu
Date de laborator:
exceptand:
teste de corectie
nivel de activitate FvW
Ac antifosfolipidici
nivel seric FVIII
Plan de investigatii?
Indici eritrocitari
Feritina serica
Electroforeza hemoglobinei
Test Koller
Teste corectie
Laborator:
Hb-6,6 g/dl, Ht-22,8%, MCV n, Tr-normale, L - n
aPTT 75
TQ n
INR n
FR, ANA, Ac antifosfolipidici - absenti
Ce diagnostic nu se potriveste cu tabloul descris?
hemofilie
purpura trombocitopenica idiopatica
boala von Willebrand
CID
Necesare pt stabilire diagnostic?
Teste de corectie
Activitate FVIII
Inhibitor FVIII
Agregometrie
Teste de fragilitate capilara
D-dimeri