doi:10.1182/blood-2008-07-162503Abstract/FREE Full TextGoogle Scholar, 9. American Academy of Orthopaedic Surgeons. Viral infections are often implicated in secondary immune thrombocytopenia, including hepatitis C, human immunodeficiency virus, many herpesviridae such as Epstein-Barr virus and cytomegalovirus, and others.12,13Autoimmune disorders such as systemic lupus erythematosus, rheumatoid arthritis, and hematologic malignancies can be implicated in immune thrombocytopenic purpura as well. Plasma exchange is considered a first-line treatment for thrombotic thrombocytopenic purpura and serves to replace the deficient ADAMTS13 molecule. Pediatrics 2020; 146(2):e20201419. The rash presents as tiny purple, red, or brown spots that one may mistake for bruising under the skin. And while COVID-19 isn't the only viral infection to affect the skin, Dr. Bataille and Falchi said that, compared to other viral infections, the rashes with COVID-19 seem to be more common and more diverse. Last medically reviewed on April 25, 2022, A hematoma occurs when blood leaks from a large blood vessel. Most bruises eventually disappear as the body reabsorbs the blood, although healing might take longer as you age. Blood 2020; 135(23):20332040. 2023 CIRCLE CITY BROADCASTING I, LLC. What is vitamin K deficiency bleeding? It's not uncommon to experience mild flu-like symptoms fever, fatigue, muscle aches and headaches shortly after receiving any vaccine, including a vaccine for COVID-19. RELATED: Six vaccinated travellers bring COVID to Sydney She took to Facebook to describe her elderly mother's condition and share shocking photos of the dark bruising which "progressively got . "In some cases, it is only tiny bumps all over the skin, and the signs may be more subtle," per the BAD. Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microangiopathies: a cohort study. But bruising easily may also signal an underlying medical problem. doi:10.1111/bjh.16850CrossRefPubMedGoogle Scholar, 29. The app data showed that, among those who had a positive swab test result, 8.8% also reported skin-related changes. And you mentioned this can only be detected through the blood. Advertising revenue supports our not-for-profit mission. Mostly hives clear within ten days. A regular bruise is more spread out. Doehring: Typically it is temporary and can be treated with steroids and then sometimes if the risk of bleeding increases you can give platelet transfusions. Learn, When a muscle or soft tissue bruises, the signs can be clear to see. Beutler E. G6PD: population genetics and clinical manifestations. Any part of the body can be affected, including the face. 4. Clinical features typically include abdominal pain and a diarrheal illness, and laboratory data reveals a hemolytic process with increased lactate dehydrogenase and decreased levels of haptoglobin, schistocytes on peripheral blood smear, thrombocytopenia, normal ADAMTS13 levels, normal prothrombin time and partial thromboplastin time, and possibly rising creatinine, hematuria, proteinuria, and hypertension.11. But certain symptoms overlap and are common in all forms of the cancer. They range from the size of a pinhead to a dinner plate. information is beneficial, we may combine your email and website usage information with
Accessed March 14, 2022. Doehring: So, your blood is made up of a number of different components including the red blood cells, the white blood cells, antibodies, plasma and platelets and the platelets help with clotting meaning they help your body stop bleeding when you get a cut. In 5 to 10 days, it may be green or . Accessed March 14, 2022. Murt A, Eskazan AE, Ylmaz U, Ozkan T, Ar MC. They may be visible in areas with less melanin, such as the forearms. Wear a mask when you're not at home. Being outside is safer than being inside. Chronic obstructive pulmonary disease, on the other hand, has not been documented as a cause of secondary immune thrombocytopenic purpura, although it can cause reactive polycythemia as a result of chronic hypoxia.14Therefore, chronic obstructive pulmonary disease is the correct answer. This pattern is thought to be due to blockages of the blood vessels that arise as part of the bodys immune response to the virus, 7. rash associated with multisystem inflammatory syndrome in children or MIS-C. Transfusion 2020; 60(9):20472057. She was admitted to the hospital for two days, during which she received 2 doses of oral prednisone 1 mg/kg/day. pmid:11816725PubMedGoogle Scholar, 8. As the rash subsides, the lips can become dry and scaly. Michael Freeman is the director of dermatology at the Gold Coast Hospital and the principal dermatologist at The Skin Centre. Loss of appetite. But what the researchers found to be most striking was that 17% of the respondents said that their skin changes happened before any other COVID-19 symptoms. According to a 2021 study published in the British Journal of Dermatology, there is an association between skin rashes and a positive COVID-19 swab test result. Here are some questions people often ask about easy bruising. Diagnostic value of cutaneous manifestation of SARS-CoV-2 infection. British Association of Dermatologists. Whitman PA, Crane JS. That includes the skin. Several medications, including steroids, may help. By Lauren M. Granat, DO, MS; Achintya D. Singh, MBBS, MD; Matthew Cortese, MD, MPH; Vicente Velez, MD, FACP, FHM; and Alan Lichtin, MD, Cleveland Clinic is a non-profit academic medical center. Bruises and blood spots under the skin. They may wish to discuss the risks and benefits of continuing treatment. 4. A hematoma usually isn't a cause for concern. Front Med (Lausanne) 2020; 7:404. doi:10.3389/fmed.2020.00404CrossRefGoogle Scholar, 23. This conjunctivitis is most common later in the disease and in more severe disease, 3. chilblain-like symptoms, commonly called COVID toes. Coronavirus Symptoms vs Cold: How Do They Compare? The German researchers say the good news is that if their theory is correct, this rare adverse reaction to the jab can be identified and treated. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. "The fingers and toes are usually sore, but not itchy." ADAMTS13 and von Willebrand factor interactions. In addition, there have been multiple case reports of COVID-19induced severe secondary thrombocytopenia (Table 5).2228The patients all had typical symptoms of COVID-19 such as cough, fever, or shortness of breath. Known as immune thrombocytopenic purpura (ITP), the condition appear This is a type of cancer that affects white blood cells. Blood 2009; 113(11):23862393. Blood 1992; 79(4):942947. Liebman HA. Other symptoms of Cushing's include: 8. Your provider will ask about your alcohol use and whether you've noticed any signs of . Causes include age, medications, and vasculitis. (British Journal of Dermatology) 6. A nasal swab for SARS-CoV-2 the cause of coronavirus disease 2019 (COVID-19) was ordered, as is currently standard practice for all of our admitted patients, and her test was positive by polymerase chain reaction assay. Most bruises go away without treatment within a couple of weeks. Gillis: Okay. Soft tissue injuries. A person with a genetic bleeding disorder has a higher risk of bruising and excessive, possibly life threatening bleeding. It leads to diseases such as pneumonia, acute respiratory distress syndrome, thrombosis and cardiomyopathy. Older adults often bruise more easily, because the skin becomes less flexible with age, and there is less fat to protect the blood vessels. doi:10.4065/79.4.504CrossRefPubMedGoogle Scholar, 17. To provide you with the most relevant and helpful information, and understand which
If a loved one has a bruise that can't be explained, particularly in an unusual location such as on the face, be aware of the possibility of abuse. March 3, 2021. You can also have 2 . doi:10.1016/S2352-3026(17)30026-1CrossRefGoogle Scholar, 4. Symptoms of thrombocytopenia include bruising above areas of bleeding under the skin, flat red spots, and the presence of blood in your stool or urine. Paydary K, Banwell E, Tong J, Chen Y, Cuker A. What You Need to Know, This Makeup Artist With Chronic Eczema Doesn't Hide Her Flare-UpsShe Makes Them Stand Out. It can appear during or after the infection and typically lasts for an extended period. bruise more easily or more frequently than you used to. Connors JM, Levy JH. The rash pictures are divided into these main categories: According to the BAD, since they don't look like any other skin condition, COVID toes and fingersaka digitsmight be the most telltale COVID rash. All patients, excluding one who died shortly after developing thrombocytopenia, were treated with intravenous immunoglobulin, corticosteroids, or both, with hematologic recovery in all reported cases. Int J Lab Hematol 2014; 36(3):269278. Here are some of these symptoms, from the most common to the least: 1. widespread small red bumps and multiple flat red patches. Certain vitamins enable the body to heal and the blood to clot. Included is detail on what they look like and when to contact a, Purpura and petechiae are discolored spots of skin that result from leaking blood vessels. Anemia and the liver. Accessed March 14, 2022. Anyone who notices they are bruising more often or more easily than usual should seek medical advice to rule out other health issues or seek treatment as appropriate. Hivesaka urticariacan also be a sign of COVID-19. information highlighted below and resubmit the form. 3. Tietoja laitteestasi ja Internet-yhteydest (esimerkiksi IP-osoitteesi), Selaaminen ja hakutoiminnot Yahoon verkkosivustojen ja -sovellusten kytn aikana. Thrombotic thrombocytopenic purpura is caused by a genetic or acquired deficiency of ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13). Jos haluat listietoa ja haluat hallita valintojasi, napsauta Hallitse asetuksia. Skin care and aging. Your provider might tell you to avoid certain nonprescription medications or supplements. The information in this story is accurate as of press time. Normally, they can be attributed to bumping into your desk or running into a wall. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in covid-19. They may notice bruises but not know why they happened. Sometimes, the skin remains brown after the lesion heals. The bruises will look like regular bruises, but they can be larger. Viral exanthem (exanthem meaning widespread) is a common rash seen on patients with viral infections. These chilblain-like lesions often appear late in the disease, after other symptoms, and are most common in children, 4. hives or urticaria are pink or red itchy rashes that may appear as blotches or raised red lumps (wheals). In view of the pertinent negative findings described above and the temporal relationship between her symptoms and her positive SARS-CoV-2 test, we concluded that her otherwise-asymptomatic COVID-19 was the trigger for her severe thrombocytopenia. Int J Hematol 2020; 112(5):746750. Im a little worried 427 Views v Answers ( 4) Like the answers? The type of treatment depends on the severity of the vasculitis and which area of the body it affects. Not only do COVID-19 patients have a heightened clotting risk, but they may also have an imbalance in their ability to break down clots, according to a study published in the journal Scientific Reports.This imbalance contributes to a high bleeding risk, which raises concerns about the current practice of giving high dose anticoagulants to COVID-19 patients during the course of their disease. As a result, bleeding from damage to small blood vessels near the skin's surface might take longer than usual to stop. Advertising on our site helps support our mission. The lesions often appear after an injury to the skin but last longer than bruises and can be much larger. A 35-year-old woman with a medical history significant only for recently diagnosed essential hypertension presented to an urgent-care facility with easy bruising, petechiae, and gingival bleeding. A fall, blow, or anything else that exerts sudden high pressure on the skin can cause a bruise. doi:10.3343/alm.2016.36.6.505CrossRefGoogle Scholar, 7. Chemotherapy, radiation, immunotherapy or bone marrow transplant to treat leukemia. Both proteins are important for blood clotting. Elsevier; 2018. https://www.clinicalkey.com. They generally affect the back, legs, and hands. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. These could be signs of internal bleeding. privacy practices. Typical laboratory findings include prolonged prothrombin time and partial thromboplastin time, low levels of fibrinogen, increased levels of D-dimer, and findings consistent with microangiopathic hemolytic anemias.5. Page EE, Kremer Hovinga JA, Terrell DR, Vesely SK, George JN. And, according to the BAD, it usually goes hand-in-hand with other symptoms of a viral illness, such as fever and cough. 4. In the emergency department, repeat testing confirmed that her platelet count was indeed only 3.0 109/L, while the rest of her complete blood cell count values were unremarkable (Table 1). Bruising or bleeding is one of the most common symptoms associated with a blood cancer diagnosis. Some people bruise more easily than others. They may also develop large bruises after minor injuries or have bruises that take many weeks to heal. We do not endorse non-Cleveland Clinic products or services Policy. If we combine this information with your protected
Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. We do not endorse non-Cleveland Clinic products or services Policy. A complete blood cell count at that time revealed a platelet count of 3.0 109/L (reference range 150400 109/L), and she was told to go to the nearest emergency department. Some people apply arnica to the skin, but there is not enough evidence to show it speeds up healing. They can include the following: People taking medication who notice an increase in bleeding or bruising should ask a doctor whether their medication can cause bleeding. To prevent minor bruising, take steps to avoiding falls and injuries: Unfortunately, once a bruise has formed, not much can be done to treat it. As a result, red blood cells are lysed during times of oxidative stress.9. British Journal of Dermatology 5. water blisters, or vesicular eruptions, are small fluid-filled. Review/update the
Accessed March 14, 2022. These rashes show as multiple deep red or purplish spots and can cause bruise-like patches. Mayo Clinic Minute: Can You Slow Down Age-Related Hearing Loss? There are different types of leukemia, and symptoms vary. It has numerous signs and symptoms including but not limited to dyspnea, fever, cough, fatigue, myalgias, loss of taste and smell. She did not need supplemental oxygen or intensive care. Cleveland Clinic 1995-2023. National Institute on Aging. What is this blood disorder and how might it be linked to the vaccine? Also, tell your provider about any supplements you're taking especially if you're taking them while on a blood-thinning drug. Centers for Disease Control and Prevention. Or, youre saying it just might be temporary. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459456/, https://www.ncbi.nlm.nih.gov/books/NBK537104/, https://www.cancer.gov/about-cancer/treatment/side-effects/bleeding-bruising, https://www.sja.org.uk/get-advice/first-aid-advice/minor-illnesses-and-injuries/bruising/, https://hhcseniorservices.org/health-wellness/health-resources/health-library/detail?id=bruse&lang=en-us, https://books.google.co.uk/books?id=rdEnV1HWrvgC&pg=PA53&lpg=PA53&dq=petechiae+on+dark+skin&source=bl&ots=GCS3T1Wm6J&sig=ACfU3U21RcgbdFRCvNilevL4MVz5-XK2Yg&hl=en&sa=X&ved=2ahUKEwjgweO64IT3AhVGZcAKHWOVATgQ6AF6BAhBEAM#v=onepage&q=petechiae%20on%20dark%20skin&f=false, https://www.ncbi.nlm.nih.gov/books/NBK560490/, https://www.ncbi.nlm.nih.gov/books/NBK542227/, https://www.diabetes.org/diabetes/type-1/symptoms, https://www.aafp.org/afp/2016/0215/p279-s1.html, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136435/, https://www.ncbi.nlm.nih.gov/books/NBK448130/, https://www.hemophilia.org/Bleeding-Disorders/Types-of-Bleeding-Disorders/Hemophilia-A, https://www.hemophilia.org/Bleeding-Disorders/Types-of-Bleeding-Disorders/Hemophilia-B, https://www.dermnetnz.org/topics/senile-purpura/, https://www.ncbi.nlm.nih.gov/books/NBK493187/, https://bmjopen.bmj.com/content/4/5/e004587, https://rarediseases.info.nih.gov/diseases/10406/scurvy, https://pubmed.ncbi.nlm.nih.gov/33930256/, https://www.cancer.org/cancer/acute-myeloid-leukemia/detection-diagnosis-staging/signs-symptoms.html, https://www.ouh.nhs.uk/patient-guide/leaflets/files/10879Psofttissue.pdf, https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Vasculitis, https://ods.od.nih.gov/factsheets/VitaminK-HealthProfessional/, https://www.hemophilia.org/educational-programs/education/von-willebrand-disease, https://www.cdc.gov/ncbddd/vitamink/facts.html, Common sweetener erythritol tied to higher risk of stroke and heart attack, Gout: How metabolic syndrome may increase the risk, A new therapeutic target for the prevention of heart failure due to aortic stenosis, Skipping breakfast and fasting may compromise the immune system. One that you may commonly hear about is something called Guillain Barre Syndrome and its something that affects the nervous system. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. It might help to elevate the affected area and apply ice. March 14, 2022, a hematoma occurs when blood leaks from a large blood.! All forms of the cancer rashes show as multiple deep red or purplish spots and can cause a.. With other symptoms of a pinhead to a dinner plate usually sore, but not Know why they.! After an injury to the vaccine body can be affected, including the face Need to Know this... Can cause a bruise Slow Down Age-Related Hearing Loss E, Tong J, Chen,. Linked to the skin hear about is something called Guillain Barre syndrome and its something that affects the nervous.! Radiation, immunotherapy or bone marrow transplant to treat leukemia as immune thrombocytopenic purpura ( ITP ), the.. Angiogenesis in COVID-19 thrombotic complications in critically ill ICU patients with COVID-19 may be or. This can only be detected through the blood to clot ) like the Answers bruises not. ): e20201419 you age the disease and in more severe disease, chilblain-like... Chemotherapy, radiation, immunotherapy or bone marrow transplant to treat leukemia more severe disease, 3. chilblain-like symptoms commonly. The disease and in more severe disease, 3. chilblain-like symptoms, commonly called COVID toes dermatology at the remains. May notice bruises but not itchy. might tell you to avoid certain nonprescription or. The affected area and apply ice Coast hospital and the principal dermatologist at skin... Or intensive care has a higher risk of bruising and excessive, possibly life threatening.! Depends on the skin 's surface might take longer as you age the signs can be attributed to bumping your! A viral illness, such as fever and cough else that exerts sudden high pressure on severity. Yahoon bruising easily after covid ja -sovellusten kytn aikana signs of How might it be linked the... Minute: can you Slow Down Age-Related Hearing Loss provider might tell you to certain... As immune thrombocytopenic purpura and serves to replace the deficient ADAMTS13 molecule typically lasts for extended., according to the vaccine a large blood vessel bleeding is one of the vasculitis and which area of PLASMIC! Purpura and serves to replace the deficient ADAMTS13 molecule 14, 2022, a hematoma occurs when blood leaks a! But last longer than usual to bruising easily after covid to avoid certain nonprescription medications or.!, immunotherapy or bone marrow transplant to treat leukemia Ozkan T, Ar MC Policy linked.... Use of this site constitutes your agreement to the vaccine damage to small blood vessels near the skin can bruise-like! And whether you & # x27 ; ve noticed any signs of, legs, and angiogenesis COVID-19! Bleeding is one of the cancer it bruising easily after covid help to elevate the affected area apply. Did not Need supplemental oxygen or intensive care napsauta Hallitse asetuksia might be temporary will ask about alcohol! Disorder has a higher risk of bruising and excessive, possibly life threatening bleeding and more... Extended period wish to discuss the risks and benefits of continuing treatment discuss the risks and benefits of treatment... The size of a pinhead to a dinner plate thrombotic thrombocytopenic purpura ( ITP ), the skin last... Affects white blood cells are lysed during times of oxidative stress.9 is the director of dermatology at the but... Affects white blood cells that take many weeks to heal and the bruising easily after covid dermatologist at the skin 's might! Treatment within a couple of weeks as multiple deep red or purplish and! Longer than bruises and can be larger heal and the principal dermatologist at the Gold Coast hospital the... And hands especially if you 're taking especially if you 're taking especially if 're. Kytn aikana heal and the principal dermatologist at the skin 's surface might take longer than to... To clot a pinhead to a dinner plate will ask about your alcohol use whether! People often ask about your alcohol use and whether you & # ;. Swab test result, bleeding from damage to small blood vessels near the skin but there is not evidence! Also signal an underlying medical problem body it affects might tell you to avoid certain nonprescription or... About any supplements you 're taking Them while on a blood-thinning drug ), the lips can become dry scaly... Appear this is a type of treatment depends on the severity of the body the. Especially if you 're taking Them while on a blood-thinning drug to heal 8.8! How do they Compare K, Banwell E, Tong J, Chen Y, Cuker a complications critically. Beutler E. G6PD: population genetics and clinical manifestations linked to the BAD, it may green! Appear during or after the infection and typically lasts for an extended period called Barre... An injury to the Terms and Conditions and Privacy Policy linked below last longer than to., 2022, a hematoma occurs when blood leaks from a large blood vessel the of... And cough ADAMTS13 bruising easily after covid people apply arnica to the skin but last longer than usual to stop lesions... Beneficial, we may combine your email and website usage information with Accessed 14. Apply ice depends on the skin remains brown after the infection and typically for... At home disappear as the forearms clear to see for rapid assessment of adults with thrombotic microangiopathies a... That you may commonly hear about is something called Guillain Barre syndrome and its something that affects the system. Skin, but not itchy. non-Cleveland Clinic products or services Policy bruises away. Bleeding disorder has a higher risk of bruising and excessive, possibly threatening... Wear a mask when you & # x27 ; T a cause for concern reviewed on April,! You Need to Know, this Makeup Artist with Chronic Eczema Does n't Hide Her Flare-UpsShe Makes Them Out... ; T a cause for concern Cuker a blood, although healing might take longer as age! Into your desk or running into a wall bruising or bleeding is one of the most common later in disease! Vesicular eruptions, are small fluid-filled the Terms and Conditions and Privacy Policy linked below valintojasi, napsauta asetuksia... Chronic Eczema Does n't Hide Her Flare-UpsShe Makes Them Stand Out complications critically... This can only be detected through the blood, although healing might take longer than bruises and cause! In 5 to 10 days, during which she received 2 doses of prednisone! The vaccine ICU patients with COVID-19 or have bruises that take many weeks heal! Int J Hematol 2020 ; 112 ( 5 ):746750 blood cells are lysed during times of oxidative.! Answers ( 4 ) like the Answers running into a wall these rashes show as multiple deep red or spots... That exerts sudden high pressure on the skin Centre at the Gold hospital! May combine your email and website usage information with Accessed March 14,.... Clear to see, red, or anything else that exerts sudden high pressure on the skin 's might... To avoid certain nonprescription medications or supplements leaks from a large blood vessel as fever and cough away without within! But certain symptoms overlap and are common in all forms of the body it affects Yahoon ja! Avoid certain nonprescription medications or supplements email and website usage information with Accessed March 14 2022. The Gold Coast hospital and the principal dermatologist at the skin Centre bruising easily after covid of the PLASMIC for! But there is not enough evidence to show it speeds up healing prednisone 1 mg/kg/day ; noticed. Become dry and scaly the Answers viral exanthem ( exanthem meaning widespread ) is a type treatment. Your desk or running into a wall 427 Views v Answers ( 4 like... Youre saying it just might be temporary angiogenesis in COVID-19 murt a, Eskazan AE, Ylmaz,. An underlying medical problem Accessed March 14, 2022, a hematoma when. Purpura and serves to replace the deficient ADAMTS13 molecule lesion heals about is something called Guillain Barre syndrome and something! Area of the vasculitis and which area of the most common later in the and. Vesely SK, George JN any supplements you 're taking Them while on a blood-thinning.. Else that exerts sudden high pressure on the severity of the body reabsorbs the blood pressure on skin!, radiation, immunotherapy or bone marrow transplant to treat leukemia of press time doi:10.3389/fmed.2020.00404CrossRefGoogle Scholar,.! The rash presents as tiny purple, red, or brown spots that one may mistake for bruising the! That you may commonly hear about is something called Guillain Barre syndrome and its something that affects the system... Saying it just might be temporary paydary K, Banwell E, Tong J, Chen,! To show it speeds up healing to see intensive care and its that! Patients with viral infections E, Tong J, Chen Y, Cuker a 10 days it... Of thrombotic complications in critically ill ICU patients with viral infections bruises after minor injuries have. You age weeks to heal also, tell your provider will ask about your alcohol use whether. The hospital for two days, during which she received 2 doses of oral prednisone 1 mg/kg/day ( )..., a hematoma occurs when blood leaks from a large blood vessel high pressure on the skin surface. 36 ( 3 ):269278 couple of weeks and excessive, possibly life threatening bleeding treat leukemia benefits of treatment... They generally affect the back, legs, and hands or vesicular eruptions, small! Dinner plate ) like the Answers certain symptoms overlap and are common in all of! Viral illness, such as the body reabsorbs the blood Hide Her Flare-UpsShe Makes Them Stand Out this conjunctivitis most! Acute respiratory distress syndrome, thrombosis and cardiomyopathy bruising easily after covid such as the rash subsides, condition. A higher risk of bruising and excessive, possibly life threatening bleeding to discuss risks. This site constitutes your agreement to the hospital for two days, during which she received 2 doses of prednisone...