Our followers have come up with a very comprehensive list of investigations! Our advice/investigation included
- stopping apixaban
- Checking Fbc ? Any other abnormalities/previous FBC/ clot in sample
- coagulation. Prolonged PT, normal aptt and fibrinogen
- renal and liver function
- HIV, hepatitis serology
- autoimune screen
- blood film to check for platelet clumps, primitive cells, size of platelets, red cell fragments
- Review medications ? Any that cause thrombocytopenia
- viral serology
- history ? Any red flags for malignancy
- examination for lymphadenopathy, hepatosplenomegaly
- Bleeding history/alcohol history/transfusion history
Blood film showed genuine thrombocytopenia, no platelet clumps, no red cell fragments and leuckocytes were normal in morphology. No primitive cells seen. the rest of the full blood count was normal, including the MCV.
The patients doctor had contacted him following your discussion, and advise him to seek medical attention if bleeding. Overnight the patient had noted a fresh PR bleed and presented himself to accident and emergency.
How would you manage this patient?
His last dose of apixaban was 18hours ago.