Approach to bleeding disorders (thrombocytopenia) Quiz: Ace Your Exams
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An 18-year-old woman presents to the emergency department with four-days of nausea vomiting, diarrhea, and fatigue and new bruising on her arms and legs that is unrelated to trauma. She has no significant past medical history. Temperature is 37.9ºC (100.3°F), heart rate is 112/min, blood pressure is 96/42 mmHg, respiratory rate is 20/min, and oxygen saturation is 99% on room air. On physical examination, the patient appears pale and is alert and oriented. Skin examination shows widespread petechiae and several large ecchymoses on the upper and lower extremities bilaterally. No facial rash is present. Abdominal exam shows mild diffuse tenderness but no rebound or guarding. Laboratory results are shown below. A peripheral blood smear reveals numerous schistocytes. Which of the following additional features would be most consistent with the likely underlying diagnosis?
| Laboratory value | Result |
| Serum chemistries | |
| Hemoglobin | 9.4 g/dL |
| Hematocrit | 28 % |
| Leukocyte count | 12,100 /mm3 |
| Platelet count | 88,000/mm3 |
| Creatinine | 2.2 mg/dL (baseline 1.1 mg/dL) |
| Lactate dehydrogenase | 445 U/L |
| Haptoglobin | Undetectable |
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