July-August 2019, Volume 16, Issue 4
A Woman With Thrombocytopenia Status Post-Partial Gastrectomy
Published on: June 12, 2019
A 62-year-old woman presented to the emergency department with abdominal pain and weakness; she has a medical history significant for end-stage renal disease secondary to focal segmental glomerulonephritis status after directed donor kidney transplantation two years ago. A computed tomography (CT) scan revealed pneumoperitoneum. She emergently underwent exploratory laparotomy with distal gastrectomy and gastrojejunostomy.
Upon admission, her platelet count was 96 × 103/µL (reference range [RR], 150-450 × 103/µL), approximately five days post-surgery her mental status waned, and platelet count decreased to 9 × 103/µL.
Other notable tests produced the following results:
| ||Value||Reference Range|
|Serum creatinine (mg/dL)||3.6||0.5-1.4 (baseline, 3.4)|
|Lactate dehydrogenase (U/L)||1,280||116-245|
|International normalized ration||2.3||0.9-1.1|
|Mean corpuscular volume (fL)||87||81-99|
|Haptoglobin (mg/dL)||< 20||51-192|
|D-dimer (µg/mL)||> 20||< 0.40|
|Total bilirubin (mg/dL)||7.2||0.1-1.0|
|Unconjugated bilirubin (mg/dL)||2.7||0.1-1.0|
|Conjugated bilirubin (mg/dL)||4.5||0-0.3|
|Tacrolimus level (ng/mL)||20.8||5-20|
|ADAMTS13 functional level||24%||69-133%|
|ADAMTS13 inhibitor||< 0.5||< 0.5|
|C3 complement level (mg/dL)||78||83-188|
|C4 complement level (mg/dL)||12||18-45|
|PF4 ELISA (OD)||0.152||< 0.4|
Abbreviations: ADAMTS13, A disintegrin and metalloproteinase with thrombospondin-1-like domains 13; ELISA, enzyme-linked immunosorbent assay.
Giemsa-stained peripheral blood smear.
Giemsa-stained peripheral blood smear (high power).
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