Thrombotic microangiopathy Quiz: Ace Your Exams
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A 37-year-old woman is brought to the emergency department for malaise, confusion, abdominal cramping, and nausea for the past 3 days. The patient's partner states that she has been confused for the past day, not knowing where she is. She has no significant past medical history and takes no medication. Temperature is 38.6 C (101.5 F) pulse is 99/min, respiratory rate is 16/min, blood pressure is 136/76 mm Hg, and oxygen saturation is 99% on room air. On physical examination, the patient appears fatigued. She is awake but not oriented to time or place. Abdominal examination reveals generalized tenderness to palpation without rebound or guarding. A Mild purpuric rash is present on the extremities bilaterally. The rest of the neurologic examination is non-focal. The results of laboratory tests are shown below. Peripheral blood smear demonstrates schistocytes, coagulation profile is normal, and ADAMTS13 activity is significantly decreased with an inhibitor detected. Which of the following is the best next step in management?
| CBC | Result |
| Hemoglobin | 8.2 g/dL |
| Leukocyte count | 14,100 /mm3 |
| Platelet count | 7,000/mm3 |
| Creatinine | 1.4 |
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