{
"question": "27-year-old male known case of aplastic anemia since [YEAR] admitted for abdominal pain, weakness, pallor, and pancytopenia. Initially managed as leptospirosis with AKI, however there was no improvement in renal function despite antibiotics and dialysis. Patient developed persistent severe azotemia and hypertensive episodes. Imaging (whole abdomen ultrasound): ✔ Normal liver, spleen, pancreas ✔ Kidneys normal size with preserved cortical thickness ✔ No obstruction, no hydronephrosis ✔ No mass or lithiasis HBsAg: Non-reactive Labs: Creatinine 613 → 972 → 646 → 873 µmol/L then after HD Crea 484.5 then after 1 day after still increasing 698.66 BUN elevated ABG: metabolic acidosis AST elevated Indirect hyperbilirubinemia Pancytopenia Ultrasound: Normal kidneys, no obstruction. LDH 1041 D-dimer 5 Negative direct and indirect coombs test Normal prothrombin and APTT Make a complete diagnosis and management based on Harrison and Philippine guidelines. How to order in the chart. What are lacking diagnostics and how to write in the chart in SOAP format Diagnosis and management"
}In a 27-year-old male with known aplastic anemia presenting with abdominal pain, weakness, pallor, pancytopenia, and acute kidney injury unresponsive to antibiotics and dialysis, with normal renal ultrasound, elevated creatinine, metabolic acidosis, elevated AST, indirect hyperbilirubinemia, high LDH, elevated D‑dimer, negative direct and indirect Coombs, and normal PT/aPTT, how should a complete diagnosis and management plan be formulated according to Harrison and Philippine guidelines, including chart ordering, identification of missing diagnostics, and documentation in SOAP format?
Last updated: March 4, 2026 • View editorial policy
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