CASE STUDY #1: A 43-year-old woman who is 30 weeks pregnant has presented to your clinic with a 10-day history of low extremities edema, with idiopathic hypertension (w/out a known cause) for 1 year. She had never experienced uncomfortable symptoms before, so she wasn’t on any antihypertensive drugs. There were no complaints of nausea or vomiting, and no report of upper quadrant abdominal pain.
At presentation, she had a blood pressure reading of 150/100 mmHg.
Below are the initial laboratory findings:
Hemoglobin (marker for vasoconstriction): 100 g/dL (normal 12.0 – 15.5 g/dL)
Platelet count: 80,000 per uL (normal 150,000 – 450,000 per uL)
Total Bilirubin (hemolysis): 29.8 umol/L (normal 1.71 to 20.5 umol/L)
AST (liver function): 225 units/L (normal 10 – 40 units/L)
ALT (liver function): 140 units/L (normal 7 – 56 units/L)
Albumin (urine sample) 20 g/dL (normal 3.4 – 5.4 g/dL)
1) What are you initially thinking might be going on based on this information? What additional tests/protocols would you want to order to get more information? What more would you want to know from her medical history?
2) Based on the additional information above, what is your suspected diagnosis? Based on what you know, what treatment do you recommend for this particular patient? What will you be monitoring over time?