Approach to bleeding disorders (thrombocytopenia) Quiz: Ace Your Exams
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A 22-year-old woman presents to the emergency department for evaluation of easy bruising for one week and a red rash on her legs and arms. She reports feeling generally unwell with mild fatigue. Five days ago, she was diagnosed with a urinary tract infection, and she has been taking trimethoprim-sulfamethoxazole. She has no significant past medical history and does not take any daily medications. She has no known allergies. There is no significant family history of bleeding or hematologic disorders. Temperature is 37ºC (98.6°F), heart rate is 82/min, blood pressure is 116/72 mmHg, respiratory rate is 14/min, and oxygen saturation is 99% on room air. Examination reveals scattered petechiae on the calves and arms bilaterally. Examination of the oral mucosa shows no active bleeding. Laboratory results are shown below. Peripheral smear shows thrombocytopenia with platelets that are normal size and morphology. Which of the following is the best next step in management?
| Laboratory value | Result |
| Hemoglobin | 11 g/dL |
| Hematocrit | 33 % |
| Leukocyte count | 8,100 /mm3 |
| Platelet count | 78,000/mm3 |
| PT/INR | 25 seconds |
| PTT | 28 seconds |
| Creatinine | 1.0 mg/dL |
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