一位39歲女性以頭暈、頭痛為表現

A 39-Year-Old Female Presenting with Dizziness and Headache

頭暈與頭痛為臨床常見但缺乏特異性的症狀，可能掩蓋潛在之致命性疾病。本案例報告描述一名39歲女性以頭暈、頭痛及瘀斑就醫，初步檢驗發現貧血與血小板低下，進一步血液抹片可見破裂紅血球，符合微血管溶血性貧血之表現。本案例專科護理師於非特異性症狀下，透過系統性臨床推理結合PLASMIC評分進行風險分層，作為即時臨床決策的重要依據，並於ADAMTS-13活性尚未確認前即判斷為高度懷疑血栓性血小板低下紫斑症（TTP），促成醫療團隊及早啟動血漿置換與類固醇治療，以降低神經學惡化與器官損傷風險。治療期間個案血小板數值反覆下降，最終確診為難治性TTP。本案例顯示，PLASMIC評分在高風險個案中可有效支撐及早治療決策，並突顯專科護理師於早期風險辨識、臨床判斷與跨團隊協作中的關鍵教育意義。

Dizziness and headache are common but nonspecific symptoms that may mask underlying life-threat¬ening disorders. We report the case of a 39-year-old woman who presented with dizziness, headache, and ecchymosis. Initial laboratory evaluation revealed anemia and thrombocytopenia, and a peripheral blood smear demonstrated fragmented red blood cells, consistent with microangiopathic hemolytic anemia.
Despite the nonspecific initial presentation, systematic clinical reasoning and risk stratification using the PLASMIC score were applied to guide early decision-making by the nurse practitioner. Before confirmation of ADAMTS-13 activity, the patient was clinically assessed as having a high clinical probability of thrombotic thrombocytopenic purpura (TTP). Prompt initiation of therapeutic plasma exchange and corticosteroid therapy was undertaken to reduce the risk of neurologic deterioration and end-organ damage. During treatment course, the platelet count declined repeatedly, and the patient was ultimately diagnosed with refractory TTP.
This case highlights the value of the PLASMIC score as a practical risk stratification tool to support early treatment decisions in suspected TTP. It also underscores the important role of nurse practi¬tioners in early risk recognition, clinical judgment, and interdisciplinary collaboration when managing patients with nonspecific but potentially critical presentations.