The Hematologist

July-August 2019, Volume 16, Issue 4

A Woman With Thrombocytopenia Status Post-Partial Gastrectomy

Maryam Asif, MD Pathology Resident
The University of Chicago Medicine, Chicago, IL
Kyle Parker, MD Resident Pathologist
University of Chicago Medical Center, Chicago, IL
Fatima Aldarweesh, MD Associate Professor, Associate Medical Director of Blood Bank and Transfusion Service
University of Chicago, Chicago, IL

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:

 ValueReference Range
Hemoglobin (g/dL)8.011.5-15.5
Serum creatinine (mg/dL)3.60.5-1.4 (baseline, 3.4)
Lactate dehydrogenase (U/L)1,280116-245
International normalized ration2.30.9-1.1
Mean corpuscular volume (fL)8781-99
Haptoglobin (mg/dL)< 2051-192
D-dimer (µg/mL)> 20< 0.40
Total bilirubin (mg/dL)7.20.1-1.0
Unconjugated bilirubin (mg/dL)2.70.1-1.0
Conjugated bilirubin (mg/dL)4.50-0.3
Tacrolimus level (ng/mL)20.85-20
ADAMTS13 functional level24%69-133%
ADAMTS13 inhibitor< 0.5< 0.5
C3 complement level (mg/dL)7883-188
C4 complement level (mg/dL)1218-45
PF4 ELISA (OD)0.152< 0.4

Abbreviations: ADAMTS13, A disintegrin and metalloproteinase with thrombospondin-1-like domains 13; ELISA, enzyme-linked immunosorbent assay.

Figure showing a giemsa-stained peripheral blood smear

Giemsa-stained peripheral blood smear.

Figure showing a high power giemsa-stained peripheral blood smear

Giemsa-stained peripheral blood smear (high power).



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