10-16-2010, 06:02 AM
A 42-year-old male presents to the emergency room with fatigue, lethargy, and decreased urine
output. His past medical history is notable for squamous cell cancer of the anus, which recently
was treated with combination chemotherapy that included cisplatin and mitomycin. His only
current medication is dolasetron. On physical examination the patient is pale. Vital signs are
stable. O2 saturation is 96% on room air. The examination is otherwise unremarkable.
Laboratory values include a white blood cell count of 11,000 cells/L. Hematocrit is 20%.
Platelets are 40,000 cells/L. Serum lactic dehydrogenase is 528 U/L. Creatinine is 5.1 mg/dL.
INR is 1.1. The aPTT ratio is 1.0. You ask for a peripheral blood smear to be performed. What
is the most likely diagnosis?
A. Hemolytic-uremic syndrome
B. Autoimmune hemolytic anemia
C. Evans syndrome
D. Disseminated intravascular coagulation
E. Sepsis
output. His past medical history is notable for squamous cell cancer of the anus, which recently
was treated with combination chemotherapy that included cisplatin and mitomycin. His only
current medication is dolasetron. On physical examination the patient is pale. Vital signs are
stable. O2 saturation is 96% on room air. The examination is otherwise unremarkable.
Laboratory values include a white blood cell count of 11,000 cells/L. Hematocrit is 20%.
Platelets are 40,000 cells/L. Serum lactic dehydrogenase is 528 U/L. Creatinine is 5.1 mg/dL.
INR is 1.1. The aPTT ratio is 1.0. You ask for a peripheral blood smear to be performed. What
is the most likely diagnosis?
A. Hemolytic-uremic syndrome
B. Autoimmune hemolytic anemia
C. Evans syndrome
D. Disseminated intravascular coagulation
E. Sepsis