henoch schonlein purpura (hsp) - dialog.roche.com · emergency department 16yr old within the hour...
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HSP Case Study
Previously had tonsillitis (4 weeks prior)
Generally feeling unwell
Spots (pin head) around ankle and lower leg
GP
Went shopping
Emergency Department
16yr old
Within the hour
Spreading purpuric rash
Severe joint pain
Associated epileptiform movements
Biochemistry lab results
14/03/2018 15/03/2018 16/03/2018 Units
Chemistry
Sodium 140 mmol/L
Potassium 4.3 mmol/L
Chloride 97 mmol/L
Bicarbonate 23 mmol/L
Creatinine 68 umol/L
Urea 5.9 mmol/L
CRP 7 mg/L
Randon Glucose 9.9 mmol/L
Lactate 1.9 mmol/L
CK 152 U/L
AST 17 U/L
ALT 14 U/L
Bilirubin 4 umol/L
ALP 114 U/L
GGT 20 U/L
TOTAL Protein 82 g/L
Albumin 45 g/L
Urine Chemistry
Urine Creatinine 4.7 mmol/L
Urine Protein 0.05 g/L
Prot/Creat Ratio 11 mg/mmol creat
Haematology lab results
14/03/2018 Units Reference Range
CBC
HB 142 g/L (110-160)
RBC 5.2 10^12/L (3.8-5.4)
HcT 0.42 L/L (0.36-0.46)
MCV 81 fL (50-300)
MCH 27 pg (27-34)
PLATE 349 10^9g/L (144-440)
TOTAL WBC 14.7 10^9g/L (4.0-11.0)
NEUTROPHIL 10.1 10^9g/L (2.0-7.5)
LYMPHOCYTE 3.5 10^9g/L (1.5-4.0)
MONO 1 10^9g/L (0.2-7.5)
EOSIN 0.1 10^9g/L (0.0-0.5)
BASO 0 10^9g/L (0.0-0.3)
IMM GRAN 0 10^9g/L
INR 1.1 ratio (0.9-1.1)
APTT 26 sec (23-35)
Immunology lab results
16/03/2018 Units Reference Range
Immunology
ANCA Negative
Amino Acids Normal
Immunoglobulin G 11.6 g/L (5.4-15.5)
CSF Oligo IgG Band Negative
IgG Cardiolipin 3.5 (<15)
IgM Cardiolipin 2.3 (<12)
ANA Titre <80 (<80)
Microbiology lab results
15/03/2018 16/03/2018 Units Reference Range Comment
Micro - CSF
WBC 3 /ul Gram stain: No Organism seen
RBC 1 H /ul Culture: No growth
CSF Protein 0.24 g/L (0.15-0.40)
CSF Glucose 6.9 H mmol/L (2.8-4.4)
Urine Culture
Lymphocytes <10 x10^6/L (<10x10^6/L) Culture: no growth
Red cells <10 x10^6/L (<10x10^6/L)
Epithelial cells <10 x10^6/L (<10x10^6/L)
Bacterial inhibitor not detected
Blood Cultures
Anarobic PositiveGram Stain: Gram pos Bacilli
seen
Aerobic Negative No growth after 5 days
HSP
Inflammation of small blood vessels
Children
Certain organs vessels start leaking
Rash
Race
Time of year
More common in boys than girls
Ends after four to six weeks
No long term consequence
Kidneys and Intestines
Colonoscopy of HSP affected bowel
Kidneys
Treatment
Treatment still remains controversial
Corticosteroids – use or not use
Prednisone
Treatment indicated on appearance of biopsy sample