Case 5 (8/25/2013): Patient Presentation
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Case 5 is a 63 year-old female patient who presents with gastroenteritis, symptomatic ascites and lower extremity edema due to diffuse metastatic breast carcinoma (liver, bone and retroperitoneal lymph nodes). She is s/p mastectomy, currently receiving chemo/radiation/hormonal therapy. Laboratory studies performed 4:55 hours post-admission include hemoglobin 9.0 gm/dL, MCV 88.9 and platelet count 122,000/uL. Laboratory studies performed 28:25 hours post-admission include hemoglobin 8.9 gm/dL, platelet count 120,000/uL, INR 1.7 and aPTT 31 seconds. Paracentesis is anticipated to evaluate “moderate” ascites associated with marked hepatomegaly secondary to metastatic disease.
How should this patient be managed in light of an INR of 1.7? Should this patient be given plasma and what is the goal of plasma therapy? If plasma is given, how much plasma should be given and what is the anticipated response to plasma therapy?
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