A 28-year-old woman with a 3-month history of systemic lupus erythematosus presents to the emergency department with a 5-day history of malaise, dyspnea, and dark urine. Her temperature is 38.2°C, blood pressure is 168/104 mmHg, and she has mild generalized edema. Laboratory studies show: Hemoglobin: 7.8 g/dL Platelets: 42,000/μL Creatinine: 2.9 mg/dL (baseline 0.8 mg/dL) LDH: 720 U/L Haptoglobin: <10 mg/dL (normal 30-200) Direct antiglobulin test: Negative Peripheral blood smear: Numerous schistocytes PT/INR: 1.1 (normal) Fibrinogen: 380 mg/dL (normal) Which of the following is the most likely diagnosis?
- A)Disseminated intravascular coagulation secondary to SLE
- B)Lupus nephritis with immune-mediated hemolytic anemia
- C)Drug-induced thrombocytopenia from hydroxychloroquine
- D)Atypical hemolytic uremic syndrome with C3 dysregulation
- E)Thrombotic thrombocytopenic purpuraGABARITO
Explicação
This patient presents with the pentad suggestive of TTP: microangiopathic hemolytic anemia (schistocytes, elevated LDH, low haptoglobin, negative Coombs test ruling out immune hemolysis), thrombocytopenia (42,000/μL), acute kidney injury (creatinine 2.9), feve... Ver explicação completa e trilha adaptativa →