Clinical Course -- Renal Failure, Anemia and Thrombocytopenia
At UPMC, she had worsening renal failure and total body edema. She was treated with hemodialysis during the first 3 hospital days because of oliguric renal failure. Hemodialysis was discontinued on the third hospital day when urine output improved. She received a total of 7 plasmapheresis treatments, the first three at 1.5 volumes and the last four at one volume plasma exchange with fresh frozen plasma. She required multiple packed red blood cell transfusions to maintain her hematocrit . The patient improved both clinically and from a laboratory standpoint with the above treatment during her hospital stay. Liver function test values returned to normal after the first plasmapheresis, her platelet count improved, and LDH continuously decreased with plasmapheresis. (see graph). BUN remained elevated but stable and creatinine rose, peaking on hospital day 8 at 8.7 mg/dl and trended down to 7.8 mg/dl by discharge. Systolic blood pressure remained 130-140 mmHg throughout her hospital stay. She was discharged on hospital day 9. Two weeks later, she was asymptomatic with a BUN of 16 mg/dl, creatinine 1.5 mg/dl, platelets 336,000cu mm and LDH 139 U/L.
DIFFERENTIAL DIAGNOSIS
FINAL DIAGNOSIS
At UPMC, she had worsening renal failure and total body edema. She was treated with hemodialysis during the first 3 hospital days because of oliguric renal failure. Hemodialysis was discontinued on the third hospital day when urine output improved. She received a total of 7 plasmapheresis treatments, the first three at 1.5 volumes and the last four at one volume plasma exchange with fresh frozen plasma. She required multiple packed red blood cell transfusions to maintain her hematocrit . The patient improved both clinically and from a laboratory standpoint with the above treatment during her hospital stay. Liver function test values returned to normal after the first plasmapheresis, her platelet count improved, and LDH continuously decreased with plasmapheresis. (see graph). BUN remained elevated but stable and creatinine rose, peaking on hospital day 8 at 8.7 mg/dl and trended down to 7.8 mg/dl by discharge. Systolic blood pressure remained 130-140 mmHg throughout her hospital stay. She was discharged on hospital day 9. Two weeks later, she was asymptomatic with a BUN of 16 mg/dl, creatinine 1.5 mg/dl, platelets 336,000cu mm and LDH 139 U/L.