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James Sidas

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The blood smear confirms schistocytes typical of TTP, but [[plasmapheresis |plasmapheresis]] is ruled out as a treatment. [[Splenectomy]] is the preferred alternative.
 
The blood smear confirms schistocytes typical of TTP, but [[plasmapheresis |plasmapheresis]] is ruled out as a treatment. [[Splenectomy]] is the preferred alternative.
 
However, after the splenectomy, the patient suffers a [[stroke]].This seems to rule out TTP. Central nervous system [[vasculitis]] presents with similar systems, but would have been seen on a [[CT Scan]]. [[Disseminated intravascular coagulation]] is ruled out because there is no [[bleeding]]. [[Pancytopenia]] was also suggested, but the patient's [[white blood cell]] count is normal. Foreman suggests a [[toxin]] and, despite the clean [[tox screen]], House orders an [[environmental scan]].
 
 
The environmental scan finds mouse droppings, but [[leptospirosis]] is immediately eliminated due to the lack of a [[fever]]. However, they find [[alcohol]] hidden in a vent, and [[liver]] failure explains all the symptoms. House orders a liver [[biopsy]] to confirm despite the patient's denial that he's an alcoholic. When the biopsy is normal, they realize the patient probably wasn't lying, and their attention turns to his [[kidneys]] due to an elevated [[albumen]] level. However, [[hyperkalemia]] would only explain the patient's ataxia, not the stroke. Taub suggests that may have been caused by [[ischemia|ischemic]] [[encephalopathy]]. They decide to test his kidneys. .
 
 
The testing confirms decreased kidney function. [[Rhabdomyolysis]] is suggested as the cause, but there is no [[edema]] associated with [[trauma]]. [[Multiple myeloma]] is ruled out because there is no bone pain. [[Polycystic kidney disease]] is ruled out due to a lack of [[urinary tract infection]] or flank pain. Their attention turns to the cough medicine found during the environmental scan. [[Goodpasture syndrome]] would explain the kidney failure and cough, so the team decides to start him on [[dialysis]] and [[immunosuppresants]].
 
 
However, House comes up with another use of the cough medicine. He realizes that Sidas, a genius, is operating at below normal intelligence levels and determines, correctly, that his is taking [[dextromethorphan]] to decrease his intelligence, but alcohol to prevent permanent damage to his brain. House realizes the dextromethorphan abuse explains all his symptoms and orders an intestinal [[lavage]] and [[activated charcoal]] to remove it from his system.
 
 
Sidas improves quickly, and his intellect quickly returns. However, he's soon suffering from complete numbness in his legs. [[Vitamin B12 deficiency]] would explain the anemia and numbness, but not the stroke. [[Arteriovenous malformation]] is ruled out almost immediately because the anemia would be characterized by abnormally large red blood cells. [[Bone marrow]] malignancy is ruled out because there would be no [[schistocytes]]. [[Lupus]] is ruled out because his [[ANA]] was normal.
 
 
Without any ideas, he goes to see the patient and, while they are talking, he finds out Sidas broke three ribs when he attempted [[suicide]]. House realizes the trauma resulted in [[accessory spleens]]. He orders an iron oxide scan to confirm, then orders the sixteen accessory spleens removed.
 
   
 
== Explaining the Medicine ==
 
== Explaining the Medicine ==
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* In plasmapherisis, albumin colloid is used to help replace the patient's plasma. It's the preferred choice because allergic reactions are rare, but Sidas is allergic to it.
 
* In plasmapherisis, albumin colloid is used to help replace the patient's plasma. It's the preferred choice because allergic reactions are rare, but Sidas is allergic to it.
 
* It is not well understood why a splenectomy is effective in treating TTP, but it appears the spleen plays a key role in the formation of adamsts13 antibodies.
 
* It is not well understood why a splenectomy is effective in treating TTP, but it appears the spleen plays a key role in the formation of adamsts13 antibodies.
* Vasculitis shows up on a CT Scan because the disease affects the blood vessels themselves.
 
* As its name suggests pancytopenia means levels of red blood cells, white blood cells and platelets are all low. As such, James's normal white blood cell count rules it out.
 
* OTIS CAMPBELL is a [[mnemonic]] for the types of toxic exposure. MOIST PLLACEB is an anagram[[File:Fun+with+Mnemonics+Seizures+OTIS+CAMPBELL.jpg|left|thumb|220x220px]]
 
 
* Linking high serum albumen to kidney disease is a bit of a stretch. With kidney disease, albumen levels are elevated in the urine, not the blood. High levels in the blood usually indicate either [[dehydration]] or a diet high in [[protein]].
 
* [[Potassium]] is key to the functioning of nerves. Either low or high levels can interfere with proper nerve function and lead to ataxia
 
* Although most strokes are caused by a blockage, a person can suffer stroke like symptoms if they do not receive sufficient oxygen for any reason.
 
* Rhabdomyolosis releases proteins, particularly myoglobin into the bloodstream which are poisonous to the kidneys.
 
* Similarly, multiple myeloma also produces by-products that can damage the kidneys.
 
* In high enough doses, dextromethorphan acts as a dissociative anesthetic, resulting in a decrease in brain function. When mixed with alcohol, the sedative effects are increased while the stimulant effects are decreased.
 
   
 
== In Real Life ==
 
== In Real Life ==
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