García CE, Guerrero GJ, García RJ, Mendoza NAA

Language: Spanish
References: 10
Page: 185-189
PDF size: 333.94 Kb.

ABSTRACT

The autoimmune hemolytic anemias antibody can be hot or cold, have an incidence of 70 to 80% may be idiopathic in 50 to 60% and the rest of the cases secondary to lymphoproliferative disorders, collagen disease, drugs, solid tumors, infections and inflammatory bowel disease. Case: 27 year old male starts with a runny nose, rhinolalia, malaise so Treating yourself with ampicillin 500 mg every 6 hrs x 3 days. Then drink alcohol and generalized jaundice, myalgia, arthralgia, predominantly in the hands and knees, symmetrical, nausea, vomiting and hematemesis on two occasions. Physical examination BP 90/60, HR 110, FR 16, temperature 37.7 ∞, oriented with generalized paleness of skin, icteric sclerae, mucous membranes dehydrated, parotid hypertrophy, short neck, without lymphadenopathy. Thorax with anterior axillary lymphadenopathy in 2 cm and painless. Abdomen globose at the expense of adipose tissue, liver edge was palpable 3 cm below the costal margin, soft in consistency, smooth, tender, palpable spleen 2 cm below the left costal margin, non tender, bloat in colonic frame, peristalsis of 6 per minute. Limbs without swelling or pain in joints without deformity, with preserved muscle strength and tone, capillary refill 3 seconds without edema. Leukocyte 16400, 13 300 neutrophils, lymphocytes 2530, monocytes 350, 105 eosinophils, basophils, 109, 3.82 Hb, Hct 8.07, MCV 96.8, platelets 103 000 CMH45. glucose 207, l7 BUN, creatinine 1.1, Na 133, K 3.63, Cl 108, total protein 6.3, albumin 3.6, cholesterol 120, calcium 7.8, PO2 1.1, Mg 2.6, BD 1.7 BT 9.2, BI 7.5, AST 59 ALT 78 LDH GGT 903 51. 05/04/1910: TP 15.8 seconds, PTT 22.2 seconds. Direct Coombs: positive. Peripheral blood smear: promyelocytes 1%, leukocyte cell 2 monositos 3%, neutrophils 94%, 72% erythroblasts in 100 leukocytes, has corrected WBC 20.8 x 10 3 / ml, macrocytosis and diffuse basophilia. With ESR 45 mm / m PCR rheumatoid factor 55 and 12.7 IU / ml. 05/10/1910. Packed red blood cells with Rh incompatibility so are washed and packed red blood cells are transfused in February because the patient is anemic data cor. Persisting with hemolysis data. Immunological profile are requested to report: Anti Nuclear Ab negative, anti-Smith Ab negative 3.6, positive Anti cyclic citrullinated peptide 88.1. U / ml. Management starts with pulses of methylprednisolone and metotrextate showing improvement.

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