Marriage made in heaven? - Part 1
Thousands of people go under the knife every day for various reasons. As a Physician one of the common referrals I get is to ascertain whether a patient is fit for surgery. Owing to increase in life expectancy, the patients presenting for surgery are older, have more co-morbidities and are at increased risk for complications. The ability to predict which patients are 'fit for surgery' has been long discussed in the literature; with improvement in risk assessment and identifying those at risk and tailoring the appropriate management prior to the surgery greatly reduces the complications during and post surgery.
Here is a very interesting case for you to consider:
A pleasant elderly couple, lady in crisp cotton saree and the gentleman in a vintage safari suit walked into my consultation room. The chivalrous husband offered insisted the lady go first.
Lady in her early seventies was to undergo cataract surgery and came in for a go-no go. She had no co-morbid illness, not on any medications and no significant clinical history. Clinical examination was completely normal. All the pre-surgical investigations were normal except her platelet count. Her platelet count was 70,000 (normal is between 1.5 - 4 lakhs). I enquired about any bleeding symptoms, recent history of fever, any medications and answer was negative to all of that. Not sure of why she had a low platelet count, I said we will repeat it the next day with manual counting on the peripheral smear.
Next was the husband's turn, he was 76 yrs old suffering with severe Osteoarthritis of both the knee joints and is due for knee replacement surgery. He too had no co-morbid illness, was not any medications and no other significant history other than the chronic knee pain (occasional NSAID'S/Pain killers). Clinical examination was normal. I was looking at his investigations; to my total surprise all his blood investigations were normal expect his platelet count. He too had low platelet count; it was 45,000 severe thrombocytopenia. Absolutely no bleeding symptoms. In him,I could partly explain because he has been on painkillers occasionally (NSAID'S could cause mild thrombocyopenia). I gave him the same advice of repeating the next day.
It was really surprising to see that both had low platelet count and no bleeding symptoms and all other blood counts were absolutely normal. Started wondering if there was a "common factor".
Next day they came back with these reports
Here is a very interesting case for you to consider:
A pleasant elderly couple, lady in crisp cotton saree and the gentleman in a vintage safari suit walked into my consultation room. The chivalrous husband offered insisted the lady go first.
Lady in her early seventies was to undergo cataract surgery and came in for a go-no go. She had no co-morbid illness, not on any medications and no significant clinical history. Clinical examination was completely normal. All the pre-surgical investigations were normal except her platelet count. Her platelet count was 70,000 (normal is between 1.5 - 4 lakhs). I enquired about any bleeding symptoms, recent history of fever, any medications and answer was negative to all of that. Not sure of why she had a low platelet count, I said we will repeat it the next day with manual counting on the peripheral smear.
Next was the husband's turn, he was 76 yrs old suffering with severe Osteoarthritis of both the knee joints and is due for knee replacement surgery. He too had no co-morbid illness, was not any medications and no other significant history other than the chronic knee pain (occasional NSAID'S/Pain killers). Clinical examination was normal. I was looking at his investigations; to my total surprise all his blood investigations were normal expect his platelet count. He too had low platelet count; it was 45,000 severe thrombocytopenia. Absolutely no bleeding symptoms. In him,I could partly explain because he has been on painkillers occasionally (NSAID'S could cause mild thrombocyopenia). I gave him the same advice of repeating the next day.
It was really surprising to see that both had low platelet count and no bleeding symptoms and all other blood counts were absolutely normal. Started wondering if there was a "common factor".
Next day they came back with these reports
- Lady - Platelet count -70,000, Manual count - 90,000 Smear showing Giant platelets.
- Gentleman - Platelet count -50,000, Manual count -85,000 Smear showing Giant platelets.
Bigger question still remains? The cause ? Etiology?
The only few causes for giant platelets I knew were some rare inherited disorders. I Immediately enquired if there's was consanguineous marriage the answer was No. At this point I really thought there marriage was indeed Made in Heaven!! It is almost cosmic that two individuals married have same congenital disorder of giant platelets!!!
IS IT?
What do you think?