Pathology Case Study Clinical Case No. 2

Here is our next Pathology case study its clinical correlation and how to investigate it. You should try to guess it and if you guess it writes after reading the case study scenario then must write in the comment ” I did it ”  so now lets move to our case scenario.

Clinical Case No. 2

A 35 years old female was admitted with pain lower abdomen following an abortion by village midwife 3 days back. She has been having high-grade fever and bleeding from gums for 2 days. Now, she has been unconscious for the last 3 hours. On examination, she is moderately built and nourished and unconscious. Her blood pressure and pulse are not recordable; while her respiration rate is 40/min. She has pallor +++, oral bleeding + but no jaundice, cyanosis or lymphadenopathy. Auscultation of the chest showed bilateral crepts and wheezing.

Requirements:

1. Discuss the clinical correlation with the pathogenesis of the features.

2. What is the probable diagnosis?

3. How will you investigate and confirm the diagnosis?

 

Clinical Correlation

The woman underwent an abortion under poor hygienic conditions 3 days back and therefore, developed serious sepsis. Her high-grade fever is systemic manifestation of fulminant septicemia. Her bleeding from gums is due to reduced platelet count from consumptive coagulopathy accompanying sepsis. Her unrecordable blood pressure and pulse along with rapid breathing are due to hypotension and metabolic abnormalities. She is unconscious due to metabolic derangement accompanying renal failure from hypoxia-ischaemia affecting higher centers. Thrombocytopenic bleeding is a pointer towards the development of intravascular thrombosis in septic shock.

Probable Diagnosis

Septic shock and disseminated intravascular coagulation (DIC)

Investigations:

i) CBC (haemoglobin, counts, indices), ESR, PCV, blood smear for type of anaemia.

ii) Coagulation profile (PT, PTTK, TT, FDPs, D-dimer).

iii) Blood grouping.

iv) Serology for HBV, HCV, HIV

v) VDRL.

vi) Arterial blood gas (ABG) analysis.

vii) Blood grouping.

viii) Urine examination (albumin, glucose, microscopy).

ix) Biochemical estimation: Serum sodium, potassium and calcium, renal function tests (urea, creatinine, BUN), liver function tests (bilirubin, ALT, AST, alkaline phosphatase, total proteins and AG ratio), blood glucose.

x) All cultures (blood, urine, vaginal discharge).

xi) Radioimaging X-ray chest, abdomen, ultrasound abdomen).

Credit: Harsh Mohan

 

Read Case No. 1 Here

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