Monday, June 1, 2015

Rhapsody, Rhetoric, Rhythm

A 35 year old G4P1 woman at 32 weeks gestation is referred to your obstetric practice because of an unusual ultrasound. She has not had prenatal care because she immigrated from Mexico just several weeks ago. She established care with an obstetrician who obtained an ultrasound showing ascites, pericardial effusions, and pleural effusions. She then referred the patient to you for further workup and management.

The patient does not regularly see a doctor and doesn't know about any medical problems. Her family history includes diabetes, cataracts, and dementia. Her husband is healthy but has a family history of hypertension, kidney disease, and alcoholism. The patient's other children are healthy. Her past surgical history only includes several orthopedic surgeries and exploratory laparotomies when she had a severe car accident in her early twenties. She spent time in an ICU but does not recall the details. Although she has used IV drugs in the past, she has been clean for five years. She does not drink or smoke.

Challenge: You perform the test shown above. What are you looking for?

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RaH said...

This is a Coombs test.
the first thing that comes to mind in elder patients (over 30) with history of severe accidents or surgeries is the transfusion of the wrong bloodtype.
Coombs test is supposed to diagnose the presence of erythrocyte antibodies. this is either from transfusion in the past, from the mixing of the blood of the first child and the mother during birth if no suppressant are given. Or an endogenous source, production of autoantibodies with hemolysis
the direct coombs test, tests the presence of autoantibodies, which are bound to erythrocytes, (IgG)
the indirect measures the presence of anti erothrycytes antibodies against other types of blood. this test is used in obstetrics to determine the rhesus compatibility between mother and child...
this might be the reason why she is a gravida 4 and para 1 (only one child was born living, and one is on the way)

Craig Chen said...

great explanation! your answers are better than mine! love the reasoning
Rhapsody, Rhetoric, Rhythm

Rhesus (Rh) negative women who deliver an Rh positive baby or are exposed to Rh positive blood are at risk for developing anti-Rh antibodies. Rh positive fetuses of these women are at risk for developing hemolytic disease of the fetus. The indirect Coombs test is used for screening.

Sources: UpToDate; Wikipedia.