04-20-2007, 11:15 AM
A 72-year-old man is referred for evaluation of fatigue, mucosal bleeding, and easy bruising. He has had frequent upper respiratory tract infections over the last several months. He has a very poor appetite and has lost 9 kg (20 lb) during the last 3 months. Medical history is significant for type 2 diabetes mellitus, hyperlipidemia, and long-term tobacco use. Current medications are metformin, extended-release sulfonylurea, and simvastatin. Physical examination discloses multiple bruises of the skin and oral cavity, petechiae, and dried blood in the nostrils.
Laboratory studies:
Hematocrit 27%
Mean corpuscular volume 89 fL
Leukocyte count 3200/µL
Platelet count 130,000/µL
Prothrombin time 12 s
Activated partial thromboplastin time 28 s
Blood urea nitrogen 37 mg/dL
Serum creatinine 3.2 mg/dL
Serum total protein 9.8 g/dL
Serum albumin 3.1 g/dL
Serum calcium 11.2 mg/dL
Serum protein electrophoresis IgG lambda monoclonal spike
Quantitative IgG 4.6 g/dL
Bone marrow aspirate shows markedly increased numbers of plasma cells but decreased myelopoiesis, erythropoiesis, and megakaryocytes.
Which of the following is the most likely cause of this patient™s mucosal bleeding and bruising?
(A) Thrombocytopenia
(B) Acquired factor VIII deficiency
© Disseminated intravascular coagulation
(D) Acquired platelet function defect
(E) Vitamin K deficiency due to poor appetite
Laboratory studies:
Hematocrit 27%
Mean corpuscular volume 89 fL
Leukocyte count 3200/µL
Platelet count 130,000/µL
Prothrombin time 12 s
Activated partial thromboplastin time 28 s
Blood urea nitrogen 37 mg/dL
Serum creatinine 3.2 mg/dL
Serum total protein 9.8 g/dL
Serum albumin 3.1 g/dL
Serum calcium 11.2 mg/dL
Serum protein electrophoresis IgG lambda monoclonal spike
Quantitative IgG 4.6 g/dL
Bone marrow aspirate shows markedly increased numbers of plasma cells but decreased myelopoiesis, erythropoiesis, and megakaryocytes.
Which of the following is the most likely cause of this patient™s mucosal bleeding and bruising?
(A) Thrombocytopenia
(B) Acquired factor VIII deficiency
© Disseminated intravascular coagulation
(D) Acquired platelet function defect
(E) Vitamin K deficiency due to poor appetite