A 35-year-old woman with neurologic symptoms presents with a markedly decreased platelet count. She has moderate anemia with many red cell fragments on the blood film, as well as polychromasia and nucleated red blood cells (RBCs)
The prothrombin time (PT) and partial thromboplastin time (PTT) are both normal. Which of the following is most likely diagnosis?
a. Immune thrombocytopenic purpura
b. Thrombotic thrombocytopenic purpura
c. Hemolytic uremic syndrome
d. DIC
ANS: B
Thrombotic thrombocytopenic purpura is characterized by thrombocytopenia, a microangiopathic hemolytic anemia with schistocytes (red cell fragments), and neurologic abnormalities. It is most common in women 30 to 40 years of age.
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