A condition known as thrombotic microangiopathy, which is characterized by the thrombocytopenia triad; low plaque levels, hemolytic anemia and give an organ for capillary level platelet formation, revealed the appearance of a series of complications not expected by a medical team of the Manatí Medical Center (MMC) and rare in the scientific literature.
Belinda Z Burgos
Agencia Latina de Noticias Medicina y Salud Pública
Thrombotic microangiopathy is a serious complication that is usually characterized by the trio of thrombocytopenia, which has low levels of plaque, hemolytic anemia, which can degrade the large cells to a large scale and give an organ of formation formation debit to poor identification.
And it’s the new clinical bullet that manifests as a poor male initiated three years ago and at 19 years of age with hinchazon in the pines of five months of evolution. At the moment there are visits to the external clinics of the residency program. In the physical examination of the vital institute within the normal parameters, but the doctors notarize oedeem in both wounds, a proteinuria, when the rhinoceroses are functioning well as deberian.
His treatment initiated at this time (2017) with a diuretic by diarrhea, but the patient does not regress to his sequelae.
Three years later, he was presented at the emergency room of Manatí Medical Center (MMC) with the main source of pain, vomiting and generalized calamities from two weeks of evolution. In the physical exam tenia a elevated arterial pressure, peripheral edema in the face, pain on palpation in the epigastric area in edema on both sides, continued in interview with Medicine and Public Health (MSP) the Dra.Liliana Colón Santos, of the Department of Family Medicine Dicha Hospital Institution.
“At the moment it is decided to admit the patient with an uremic syndrome – serious clinical quadrant when the rhinoceroses are critically affected- and pancreatitis . This means that there is a long and complicated hospitalization that requires work in a team of various sub-specialists. The main treatment consists of venous hydration, antibiotics, treatment of arterial pressures and emergence dialysis, as well as kidney biopsy. In the images created we find oedeem in the pancreas but the rhinos are found in normal size ”, explained the Dra. Colón Santos.
“During hospitalization our patient becomes complicated on various occasions with hemolytic anemia – degradation of the red cells – it requires various transfusion songs. Tuvo also has various hypertensive crisis events that are difficult to manage. But when it comes to many drug optimizations and consecutive dialysis we can stabilize the pressures and creatinine commences to lose weight ”, añadió.
Indicates that the patient is negatively affected by glomerulonephritis, rheumatological and myeloproliferative disorders. Sondeverbod, the rhinoplasty biopsy reported 80% fibrosis and vascular thrombosis. After a month of hospitalization the patient was given high altitude with the diagnosis of permanent renal failure in dialysis and thrombotic microangiopathy, a diagnostic retention in literature.
Thrombotic microangiopathy is a serious complication that is usually characterized by the thrombocytopenia trio, which has low plaque levels, hemolytic anemia, and an organ for capillary-level thrombus formation. The epidemiology todavia is not clearly debatable with the identification or diagnostic of the same.
Thrombotic microangiopathy alone has ten classifications. The first present thrombocytopenia is purple which is present in the Mayor of cases with thrombocytopenia severe and neurological changes. The second is a mediated hemolytic-uremic syndrome caused by shiga toxin – of bacterial origin – which is presented with diarrhea with blood and is more common in children.
“Our case does not comply with any of these criteria of its primary classification. Now, there is a surrogate third classification known as hemolytic uremic syndrome mediated by complement. Currently following the patient as much as the dialysis unit as in outpatient clinics ”, confirmed.
This disorder is rare among the cases reported with an incidence of 7 per 1,000,000 residents. For the diagnostic certainty of this syndrome, the power can identify genetic mutations. The treatment consists of plasma exchange, treatment with eculizumab, an immunosuppressant and on occasions may require renal transplant, details the Doctor.
‘Our family now, like family medicine, is working with a young patient on permanent dialect. The number is not 100 per cent in his treatment and he does not know what it means to be a renal patient. It is ideal for our patient to have a transplanted organ transplant presented with a permanent renal failure, but in order to be able to work as a psychologist, emotional state and possibly have a genetic study It is our job as professionals of health to create awareness and educate our people to follow suit with their medical citations. Many conditions, if detected in time, with the patient’s work and a good medical team can maintain its progression and on occasions has to be corrected”, reveló.
The doctors Edgar Hernández Montalvo, nephrologist at Manatí Medical Center, Ignacio Acevedo Sierra and Beth Ann Rivera Fomenta, both family medicine doctors, were part of this case report.