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1st June 2023
A 20-year-old woman is seen in the A&E department due to severe lethargy and passing dark brown urine
A 20-year-old woman is seen in the A&E department due to severe lethargy and passing dark brown urine. Past medical history includes a PE 2 years ago for which she was given apixaban for 6 months.
On examination, she appears pale, her BP is 96/58 and her HR is 109 and regular.
Investigations are shown in the table below:
| Hb | 79 g/L (reticulocytosis) | Females: (115 – 155 g/L) |
| Platelets | 128 x 10⁹/L | (150 – 400 x 10⁹/L) |
| WCC | 5.5 x 10⁹/L | (4 – 11 x 10⁹/L) |
| Na+ | 139 mmol/L | (135 – 145 mmol/L) |
| K+ | 4.3 mmol/L | (3.5 – 5.0 mmol/L) |
| Urea | 4 mmol/L | (2.5 – 6.5 mmol/L) |
| Creatinine | 75 μmol/L | (50 – 120 μmol/L) |
| Bilirubin | 41 mg/L | (2 – 17 µmol/L) |
| Haptoglobin | 0.1 g/L | Female: (0.4 – 1.6 g/L) |
| LDH | 590 IU/L | (100 – 190 IU/L) |
| Urine dipstick | Blood +
No red cells seen on microscopy |
|
How should the patient be managed given the likely diagnosis?
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