10-07-2006, 12:48 AM
A 21-year-old man with no significant past medical history presents to office with complaints of blood in his urine and mucosal bleeding while brushing his teeth. The patient complains of intermittent "ringing in the ears." He denies any drug or alcohol use. He has no family history of bleeding disorders. Petechiae are noted in the oral cavity, as is dried blood in the nostrils.
Laboratory studies show the following:
Hematocrit 32%; white blood cell count 8,000/mm3 with 60% neutrophils; platelet count 13,000; PT 13 seconds; PTT 28 seconds; LDH 1,200 U/L; elevated indirect bilirubin.
Coombs' test is positive; abdominal examination is normal; and the peripheral smear shows spherocytes.
What is the most likely diagnosis?
(A) Alport's syndrome
(B) Bernard-Soulier syndrome
© Felty's syndrome
(D) Thrombotic thrombocytopenic purpura
(E) Evans' syndrome
(F) Idiopathic thrombocytopenic purpura (ITP
Laboratory studies show the following:
Hematocrit 32%; white blood cell count 8,000/mm3 with 60% neutrophils; platelet count 13,000; PT 13 seconds; PTT 28 seconds; LDH 1,200 U/L; elevated indirect bilirubin.
Coombs' test is positive; abdominal examination is normal; and the peripheral smear shows spherocytes.
What is the most likely diagnosis?
(A) Alport's syndrome
(B) Bernard-Soulier syndrome
© Felty's syndrome
(D) Thrombotic thrombocytopenic purpura
(E) Evans' syndrome
(F) Idiopathic thrombocytopenic purpura (ITP