RT Book, Section
A1 Hillman, Robert S.
A1 Ault, Kenneth A.
A1 Leporrier, Michel
A1 Rinder, Henry M.
SR Print(0)
ID 1127768159
T1 VASCULAR PURPURA
T2 Hematology in Clinical Practice, 5e
YR 2016
FD 2016
PB McGraw-Hill Medical
PP New York, NY
SN 9780071626996
LK hemonc.mhmedical.com/content.aspx?aid=1127768159
RD 2024/04/23
AB CASE  HISTORY  •  Part  1A  46-year-old  woman  presents  with  a  complaint  of  more  than  3  months  of  fatigue  and  dyspnea  on  exertion.  Her  history  is  notable  for  lifelong  recurring  epistaxis,  requiring  repeated  nasal  packing,  septal  dermoplasty,  and  laser  therapy.  Her  father  also  had  repeated  epistaxis;  he  died  at  age  60  from  a  brain  abscess.  Examination  is  notable  for  pallor  and  multiple  blue-red  lesions  involving  the  lips  and  fingers.  The  remainder  of  the  examination  is  benign  except  for  a  positive  test  for  occult  blood  in  the  stool.CBC:  Hemoglobin/hematocrit  -  7  g/dL/22%MCV  -  64  fL  MCH  -  24  pg  MCHC  -  24  g/dLRDW-CV  -  24%  WBC  count  -  6,500/μLPlatelet  count  -  410,000/μLSMEAR  MORPHOLOGYMicrocytic,  hypochromic  with  marked  aniso-  and  poikilocytosis,  polychromasia,  and  the  occasional  cigar-shaped  cell.  White  blood  cells  and  platelets  are  both  normal.Reticulocyte  count/index  -  1.3%/<1.0QuestionsHow  should  the  anemia  be  described  and  does  the  history  suggest  a  specific  etiology?What  additional  tests  should  be  ordered  to  confirm  the  cause  of  the  anemia?