A 24-year-old female presents to your outpatient clinic having been referred due to recurrent miscarriages. She has had no successful pregnancies thus far. Her blood tests reveal the following:
APTT 42 (27-35)
Platelets 95 (150-400)
PT 12 seconds (11-14)
What is the likely cause of these abnormalities?
A. Autoimmune thrombocytopenia (AITP)
B. Antiphospholipid syndrome
C. Von Willebrand Disease(vWD)
D.Haemophilia A
E. Heparin Overdose
上期答案及解析
Question 46
A 47-year-old woman with poorly controlled type 2 diabetes, as well as hypertension and hyperlipidemia, reports a 1-month history of several new skin lesions. She denies fevers, chills, and joint pain. Her current medications are insulin, metformin, labetalol, simvastatin, and a multivitamin.
The skin lesions are reddish-yellow, pruritic, and painful. They are present on the backs of both legs and on the buttocks and knees (figures 1 and 2).
Laboratory testing reveals a glycated hemoglobin level of 11.9% (reference range, 3.8–5.6). The patient’s complete blood count, electrolytes, and kidney function are normal.
Which one of the following conditions is the most likely cause of this patient’s skin lesions?
A.Hemochromatosis
B.Cushing syndrome
C.Hypertriglyceridemia
D.Neurofibromatosis
E.Familial combined hypercholesterolemia
Answer C
Reddish-yellow papules concentrated primarily on the extensor surfaces of the legs in a patient with poorly controlled type 2 diabetes are most indicative of eruptive xanthomatosis, which occurs in patients with severe hypertriglyceridemia.
Eruptive xanthomatosis — the appearance of reddish-yellow papular skin lesions on an erythematous base, concentrated mainly on extensor surfaces of the extremities — is primarily caused by severe hypertriglyceridemia. The disorder usually responds well to triglyceride-lowering treatment, and complete resolution of the lesions is common.
Extremely elevated triglyceride levels (>2000 mg/dL) are associated with lipemic serum and an increased risk for pancreatitis, typically called chylomicronemia syndrome. Funduscopic examination may reveal lipemic retinal vessels consistent with chylomicrons. Severe hypertriglyceridemia is usually caused by a common genetic form of hypertriglyceridemia combined with an acquired disorder, most often type 2 diabetes that is untreated or poorly controlled.
Familial combined hypercholesterolemia is a disorder associated with an elevated level of LDL cholesterol; it is associated with xanthomas of the tendons and around the eyes (xanthelasmas).
Easy skin bruising and purple or red striae are the common skin findings of Cushing syndrome.
Neurofibromatosis is characterized by abnormal skin pigmentation (café au lait spots) and skin fibromas.
Hemochromatosis is characterized by tanning of the skin, not by discrete eruptive lesions.
注释
hyperlipidemia高脂血症
glycated hemoglobin糖化血红蛋白
Hemochromatosis血色沉着病
Hypertriglyceridemia 高三酸甘油脂血症
Neurofibromatosis神经纤维瘤病
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