A previously well 28-year-old woman presents with a history of mild nosebleeds and easy bruising for 8 days. She denied a history of abnormal bleeding and had been perfectly healthy, participating in a soccer league. There were no recent upper respiratory illnesses, no recent travel, and no significant trauma other than on the soccer field. Her only medication was a multivitamin pill with iron because of menorrhagia. Physical examination revealed a thin, healthy woman with normal vital signs. There were a few petechiae in her conjunctivae and mouth, and a modest-sized, healing bruise on her abdomen. There was no hepatosplenomegaly or palpable lymphadenopathy. Her laboratory findings included a Hgb of 124 g/L, WBC of 6.8 × 109/L, and platelet count of 9 × 109/L, and her blood film was normal except for markedly decreased but large platelets. Which of the following tests are indicated in her evaluation?
A. Marrow examination
B. Helicobacter pylori evaluation
C. ANA, lupus anticoagulant, and APL antibodies
D. HIV and hepatitis C virus (HCV) titers
Answer:D
A previously well 28-year-old woman presents with a history of mild nosebleeds and easy bruising for 8 days. She denied a history of abnormal bleeding and had been perfectly healthy, participating in a soccer league. There were no recent upper respiratory illnesses, no recent travel, and no significant trauma other than on the soccer field. Her only medication was a multivitamin pill with iron because of menorrhagia. Physical examination revealed a thin, healthy woman with normal vital signs. There were a few petechiae in her conjunctivae and mouth, and a modest-sized, healing bruise on her abdomen. There was no hepatosplenomegaly or palpable lymphadenopathy. Her laboratory findings included a Hgb of 124 g/L, WBC of 6.8 × 109/L, and platelet count of 9 × 109/L, and her blood film was normal except for markedly decreased but large platelets. Which of the following tests are indicated in her evaluation?
A. Marrow examination B. Helicobacter pylori evaluation C. ANA, lupus anticoagulant, and APL antibodies D. HIV and hepatitis C virus (HCV) titers