Members rudywoofs (Pam) Posted September 14, 2010 Members Share Posted September 14, 2010 The Case of the Well-Known Woman With Unexplained Anemia Albert Lowenfels, MD The Case The patient is a 75-year-old woman in reasonably good health but who now complained of weakness and fatigue. Because of anemia (hemoglobin 10 g/dL) her local doctor referred her to a hematologist who diagnosed aplastic anemia on the basis of bone marrow aspiration results. The bone marrow contained 18% myeloblasts. During the next year she required several blood transfusions, often accompanied by chills and fever. Pancytopenia developed for which she was given prednisone. The patient was rehospitalized 6 months later with vaginal bleeding, and dilation and curettagewas performed. The hemoglobin level had fallen to 8 g/dL. A bone marrow examination revealed hypocellularity and pancytopenia. She received 2 units of blood. Two years after the initial onset of symptoms, the patient was again hospitalized with a fever of 102°F and a cough of several weeks' duration. Her chest x-ray was clear except for evidence of old scarring, considered to be consistent with previous inactive pulmonary tuberculosis. After 5 days, the patient was discharged on prednisone. She continued to need occasional blood transfusions. About 6 weeks later the patient was readmitted with persistent fever and blood in the stools. Another bone marrow aspiration was performed and a sample was sent out for culture. The initial bone marrow specimen was negative for tuberculosis. During this final hospitalization her hemoglobin dropped to 3 g/dL. Her temperature increased to 105°F and she appeared to be acutely ill. At her request the patient was sent home where she soon sustained a stroke, became comatose, and died about 30 months after the initial onset of symptoms. Family and Personal History The patient's mother died at age 29 of diphtheria. Her father died of complications of alcoholism at age 34. One younger brother also died of alcoholism. Occasionally she smoked cigarettes, but was a non-drinker. Medical History The patient suffered from migraine headaches throughout most of her life. In her 30s while travelling in Europe with her husband, severe chest pain developed that was diagnosed as pleurisy. When she was in her 60s her physicians used steroids to treat symptomatic arthritis. At age 62 she fell asleep while driving, leading to a head-on crash that caused minor facial injuries. Who was the patient? Isadora Duncan Eleanor Roosevelt Ethel Barrymore Margaret Burke White What is your diagnosis? Leukemia Aplastic anemia Tuberculosis Widespread cancer from unknown primary site source Quote Pam Meddle Not In the Affairs of Dragons; for You Are Crunchy and Taste Good with Ketchup. If we all sang the same note in the choir, there'd never be any harmony. Funny, isn't it, how we accept Grace for ourselves and demand justice for others? Link to comment Share on other sites More sharing options...
Moderators Bravus Posted September 15, 2010 Moderators Share Posted September 15, 2010 Isadora Duncan died when a scarf she was wearing caught in the wheel of the convertible she was riding in, if I recall correctly. That rules her out but I don't know enough about the other ladies to make a good guess which of them it would be. I'm inclined to rule out Eleanor Roosevelt on just general vibes, but that's a weak inclination. My best diagnosis is undiagnosed TB, despite the negative test for it. That would explain the lung damage, and TB can also grow in the brain leading to the headaches and possibly the sleepiness. It can also lead to otherwise unexplained fevers, and even the excretory and reproductive organ issues. Will be very interested to see how far off the mark I am. (And we do have at least one and maybe more actual medicos here, who no doubt will be much better at this.) Quote Truth is important Link to comment Share on other sites More sharing options...
Liz Posted September 15, 2010 Share Posted September 15, 2010 My pick is Ethel Barrymore, only because the Barrymores are almost as famous for being alcoholics as they are for their movies. I don't know what the dx would be though. Leukemia? I like "whodunnits" Pam, you should do more of these. Quote For what will a man be profited, if he gains the whole world, and forfeits his soul? Mat. 16:26Please, support the JDRF and help find a cure for Type 1 Diabetes. Please, support the March of Dimes. Link to comment Share on other sites More sharing options...
Moderators Nan Posted September 15, 2010 Moderators Share Posted September 15, 2010 I don't know who, except not Isadora Duncan as Bravus said... I would go for aplastic anaemia for the diagnosis. And probably it is wrong, even though there is a small GYN component to her complaint. Quote Link to comment Share on other sites More sharing options...
Members rudywoofs (Pam) Posted September 15, 2010 Author Members Share Posted September 15, 2010 It was Eleanor Roosevelt. A tissue culture done after she died revealed ...... tuberculosis. Quote Pam Meddle Not In the Affairs of Dragons; for You Are Crunchy and Taste Good with Ketchup. If we all sang the same note in the choir, there'd never be any harmony. Funny, isn't it, how we accept Grace for ourselves and demand justice for others? Link to comment Share on other sites More sharing options...
Moderators Bravus Posted September 15, 2010 Moderators Share Posted September 15, 2010 Hehe, 1 out of 2 ain't bad! (and hey, I beat a doctor to the diagnosis!) This was fun, thanx Pam. Quote Truth is important Link to comment Share on other sites More sharing options...
Amelia Posted September 15, 2010 Share Posted September 15, 2010 That was fun Pam. How about setting them up as polls? Quote <p><span style="color:#0000FF;"><span style="font-weight:bold;"><span style="font-style:italic;">"Do not use harmful words, but only helpful words, the kind that build up and provide what is needed, so that what you say will do good to those who hear you."</span></span> Eph 4:29</span><br><br><img src="http://banners.wunderground.com/weathersticker/gizmotimetemp_both/US/OR/Fairview.gif" alt="Fairview.gif"> Fairview Or</p> Link to comment Share on other sites More sharing options...
Administrators Gail Posted September 15, 2010 Administrators Share Posted September 15, 2010 If it was tuberculosis, does that mean that she was treatable and the death at that point could have been avoided? Interesting! Quote Isaiah 32:17 And the work of righteousness shall be peace; and the effect of righteousness quietness and assurance for ever. Link to comment Share on other sites More sharing options...
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