Differential Diagnosis
- Single most likely diagnosis
- Preeclampsia with severe features: This diagnosis is the most likely due to the patient's symptoms of headache, blurry vision, and fatigue, combined with her high blood pressure (190/96 mm Hg), significant proteinuria (4+ protein), and laboratory results indicating thrombocytopenia (56,000/mm3) and elevated lactate dehydrogenase (1,648 U/L). The presence of increased ankle clonus also supports this diagnosis, as it can be a sign of hyperreflexia associated with preeclampsia.
- Other Likely diagnoses
- Chronic hypertension with superimposed preeclampsia: Although the patient has no known history of chronic hypertension, the lack of prenatal visits for the past month could have masked the diagnosis. The high blood pressure and proteinuria could be indicative of chronic hypertension with superimposed preeclampsia.
- Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome: The patient's laboratory results show thrombocytopenia, elevated lactate dehydrogenase, and a low hemoglobin level, which could be indicative of HELLP syndrome. However, the liver enzymes (aspartate aminotransferase) are not significantly elevated, making this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Eclampsia: Although the patient does not have a seizure, the presence of high blood pressure, proteinuria, and symptoms such as headache and blurry vision increase the risk of eclampsia. It is essential to monitor the patient closely for any signs of seizure activity.
- Stroke or cerebral vasculature issues: The patient's symptoms of headache and blurry vision, combined with high blood pressure, increase the risk of stroke or cerebral vasculature issues. Imaging studies may be necessary to rule out these conditions.
- Rare diagnoses
- Thrombotic thrombocytopenic purpura (TTP): The patient's laboratory results show thrombocytopenia, elevated lactate dehydrogenase, and a low hemoglobin level, which could be indicative of TTP. However, this diagnosis is rare and would require further testing to confirm.
- Atypical hemolytic uremic syndrome (aHUS): The patient's laboratory results show thrombocytopenia, elevated lactate dehydrogenase, and a low hemoglobin level, which could be indicative of aHUS. However, this diagnosis is rare and would require further testing to confirm.