Case Study#3

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More Lab Results:

• Immunoglobulins: note study done after IVIG infusions begun
  • Ig A: 100 (68-378 mg/dL)
  • Ig G: 875 (694-1617 mg/dL)
  • Ig M: 38.5 (53-334 mg/dL)
    
    
• DIC workup:
  • FSP: <10 (0-10 ug/mL)
  • D-Dimer: <0.5
  • Fibrinogen: 271(150-400 mg/dL)
    
    
• SPEP:
  • Cryoglobulin negative
• Albumin: 4.6 (3.5-5 g/dL)
• Alpha 1: 0.17 (0.1-0.4 g/dL0
• Alpha 2: 0.65 (0.4-1 g/dL)
• Beta: 0.91 (0.5-1.2 g/dl)
• Gamma: 1.36 (0.5-1.6 g/dl)
• No abnormal discrete band noted
• UPEP: No abnormal discrete band noted
• Reticulated Platelet: (5-15%)
• Platelet count: 9K, Retic Plt %: 58%
• Interpretation: The markedly elevated RP% is most consistent with severe peripheral platelet destruction such as seen in ITP, TTP, or DIC, or less commonly with platelet sequestration due to splenomegaly.
• Platelet antibody screen in serum: negative
• Presence of H-J bodies on smear makes accessory spleen unlikely - no splenic uptake on L/S scan