skip to main content

Granulomatosis with polyangiitis pulmonary-renal syndrome — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardMusculoskeletal systemGranulomatosis with polyangiitis pulmonary-renal syndromeSCE Acute Medicine

A patient has fluctuating confusion, platelets 12 × 10^9/L, haemoglobin 72 g/L, schistocytes, high LDH, normal coagulation tests and mild renal impairment. What is the immediate treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Start plasma exchange and corticosteroids for suspected TTP

The best answer is “Start plasma exchange and corticosteroids for suspected TTP”. This is correct because microangiopathic haemolysis, severe thrombocytopenia and neurological change form a time-critical TTP phenotype. Treatment must begin before ADAMTS13 confirmation. Routine platelet transfusion can worsen microvascular thrombosis unless bleeding is life-threatening, and normal PT/APTT argue against DIC or vitamin-K deficiency.

Reference: British Society for Haematology TTP and thrombotic-microangiopathy guideline: https://b-s-h.org.uk/guidelines/guidelines/diagnosis-and-management-of-thrombotic-thrombocytopenic-purpura-and-thrombotic-microangiopathies