Case 11 – update 2

The case starts just below here! – click

The patient has arrived on AMU and is being clerked by the medical SHO.

She is a 27 year old female and is fit and well.  She had a ruptured appendix last year requiring emergency surgery and had a normal FBC at the time.  She is known to have menorrhagia and is on the combined oral contraceptive pill.  She has been on and off iron tablets since she was sixteen.  She works as lawyer and has recently been on holiday to the Caribbean for a honeymoon.  She does not smoke and drinks two bottles of red wine over the weekend.  There is no history of recreational drug abuse.  he had a full blood count at her GPs after she complained of feeling very lethargic.  She does has ‘easy bruising’ but this has been present for a number of years and is not been much worse over the past week.  On examination a number of bruises are noted over the backs of the thighs and her abdomen.  She has a ‘pin-prick’ rash over her shins.  No neurological signs are elicited and cardio-respiratory examinations are unremarkable.

Other blood tests that were done by the GP included U&E, LFT and TSH which were all within the reference ranges.


  • Is there anything you want to know in the history?
  • What are your differential diagnoses?
  • Any further tests?

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