Case 147 – Update 1

We have a 34 year-old female patient who has presented with headache, thrombocytopenia (plt 25) and intracranial haemorrhage requiring a decompressive craniectomy which was supported with 2 pools of platelets pre-operatively and a further pool intra-operatively. She is now on the neurosurgical ICU and is stable, but remains intubated and ventilated.

You have collated other results:

U&Es, LFTs, bone profile, CRP all normal

Coag screen: PT 13, APTT 35, Clauss Fibr 4.1 (within normal ranges for your lab)

Film: True thrombocytopenia. No fragments, no primitive cells. No large platelets. No clear morphological cause for thrombocytopenia ?ITP

You have also collected some more information from GP records:

No significant past medical history, no regular meds, no known alcohol excess

Only recent GP record (13 days ago) is for her first ChAdOx1 nCoV-19 (AstraZeneca) vaccine

Are there any further investigations you would suggest?

Would you consider any other treatment at this time?

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