You have reviewed the film and concur with the finishing of marked red cell fragmentation. Thrombocytopenia is also confirmed.

You contact the A&E doctor who has reviewed the patient and they confirm as history of a possible seizure prompted hospital review. A history of alcohol excess has also been reported by the patient partner.

Patient usually fit and well, no recent travel, no new medications

Further blood tests undertaken include:

Na- 134

K- 5.4

Crest – 231

Urea – 9

DAT- negative

LDH – elevated

Coagulation screen – PT 12 APTT 33 fibrinogen 3.4

Trop T- elevated

Amylase – within normal range

Hep B/Hep C/ HIV – negative

BetaHCG- elevated

ADAMTS13- awaited as not available out of hours in your area

What is your differential diagnosis?

How would you manage this patient?

Please remember to include #teamhaem in your reply!