Case 7 – update 3

The blood film is reported by the haematology SpR and the comment states that “thrombocytopenia is confirmed on the blood film, with no evidence of platelet clumps.  The platelets seen appear normal in morphology.  There is evidence of haemolysis with RBC fragments (schistocytes) seen.  White cell morphology is normal although some of the neutrophils look left shifted indicating reactive cause.  Microangiopathic haemolytic anaemia is likely”.

The haematology SpR reviews the patient on the ward.  He is slightly confused although there is no focal neurology.  His bleeding has stopped although he has a petechial rash on his legs.  He states he was well until recently where over the past two days he’s been lethargic and intermittent epistaxis and ‘chills’.  There has been no diarrhoea or urinary symptoms.  There was no past medical history about from broken bones and an appendicectomy five years previously. He denied any regular medications or risky behaviours    On examination his chest sounds clear, heart sounds normal and no organomegaly.  There was nasal packs in situ and a petechial rash on his legs.  His GCS was 14/15 (dropped one point for disorientation).


  • Please list the differential diagnosis of MAHA and thrombocytopenia
  • Please list the investigations you’d perform to confirm the diagnosis

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