106) A 46 year old man is seen in your office for complaints of severe fatigue over the last one week. The patient was diagnosed with chronic Hepatitis – C infection 2 weeks ago for which he was started on Interferon and Ribavirin. On examination, his vitals are stable and he is afebrile. Conjunctivae are notable for pallor. Abdominal examination is benign except for mild splenomegaly.
Laboratory investigations :
WBC count of 3,ooo/µl
Hemoglobin of 5.8gm%
Platelet count of 60k/µl.
Total protein 6.8gm%
Albumin 3.2gm%
Total Bilirubin 3.2gm%
Direct bilirubin 0.8gm%
SGPT 52 U/L
SGOT 66 U/L
Alkaline Phosphatase 110U/L
Haptoglobin < 5.8
Reticulocyte count of 6.0%
Lactic Dehydrogenase 1200 IU/L
Serum creatinine 1.0
Peripheral blood smear reveals reduced platelets, polychromasia and anisocytosis. His laboratory tests 4 weeks ago were normal except for mild elevations in his liver enzymes. The immediate next step in managing this patient is :
A) Parvo virus B19 antibodies
B) Endoscopy
C) Plasmapheresis
D) Stop Ribavrin
E) Intravenos Methylprednisolone
D.Stop Rivavirin
Ribavirin causes hemolytic Anaemia in 10 % cases
Recommendation-Check Hct pretreatment,2 wks & 4 wks
***Highly Teratogenic
***Parvovirus B19 causes Aplastic Crisis in Sicle cell disease or other Hemoglobinopathies
STOP THE FLAVIN!
D
Ribavarin cause bleeding.
C it is interferon induced TTP
Muy buen articulo el que has publicado y gran blog. Muchas gracias por publicar articulos como este en tu blog..