Immune thrombocytopenia Quiz: Ace Your Exams

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A 59-year-old woman is brought to the emergency department after tripping and falling from a step stool at home and hitting her head on the floor. The patient reports a severe, diffuse headache. Past medical history is significant for immune thrombocytopenia (ITP) and hypertension. Current medications include amlodipine. The patient is currently not on any treatment for ITP and is being followed for it. Review of systems is otherwise unremarkable. Temperature is 37.0°C (98.6°F), pulse is 98/min, respirations are 18/min, and blood pressure is 120/75 mmHg. Physical examination shows a left scalp hematoma and two small ecchymoses on the left forearm. There is no evidence of petechiae, lymphadenopathy or hepatosplenomegaly. Laboratory studies are shown below. Computed tomography (CT) of the head shows extensive left temporal intracranial hemorrhage. Platelets are transfused, and neurosurgery is consulted. Which of the following is the most appropriate next step in management?

 Laboratory Test  Result
 Hemoglobin   10.2 g/dL 
 Leukocyte count  5,000/μL 
 Mean corpuscular volume (MCV)  89 fL 
 Platelet count  17,000/μL 
 Reticulocyte count  2.0% of erythrocytes 
 Creatinine  0.8 mg/dL 
 Prothrombin time (PT)  12 s 
 Activated partial thromboplastin time (aPTT)  22 s 
 International normalized ratio (INR)  1.0 
 Urinalysis  normal

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