Approach to bleeding disorders (platelet dysfunction) Quiz: Ace Your Exams

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A 55-year-old man is brought to the emergency department by his family for evaluation of lethargy and hematemesis for the past few hours. He has a known history of chronic liver disease secondary to alcohol use disorderThe patient had several episodes of hematemesis prior to presentation and has become progressively more lethargic. He last drank alcohol that morning. He takes no medications. Temperature is 37°C (98.6°F), pulse is 114/min, respirations are 22/min, blood pressure is 96/64 mmHg, and oxygen saturation is 96% on room air. The patient appears somnolent but arousable when called by his name. Dried blood is seen around his mouth and scleral icterus is present. There is mild tenderness to palpation of the epigastrium and spider angioma are present on the abdomen. Laboratory results are shown below. Which of the following is the best next step in management?  

 Laboratory test      Result     
 Hemoglobin      10.2 g/dL     
 White blood cell count      9,000 /µL     
 Platelets      44,000 /µL     
 Prothrombin time (PT) 13 seconds     
 Partial thromboplastin time (PTT) 35 seconds     

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