A 75 y/o woman with past medical history of CVA, HTN, DM type II is sent to the Emergency Room from Nursing home for evaluation of fever and altered mental status. Vitals reveal a temperature of 101F, BP 100/60, RR 22, HR 110.
Physical examination reveals an elderly woman not respond…ing to verbal stimuli but moans in response to deep pain. Echymoses are seen on lower extremities. A foley catheter is present draining cloudy urine. Lab studies show Hgb of 8.6, WBC 12K, Platelets 15k, BUN 48 and Creatinine 3.2. Prothrombin time is 14.8 and Partial thromboplastin time is 58. LDH level is elevated at 600. A peripheral blood smear is shown below Which of the following features would most likely help in identifying the etiology of this patient’s thrombocytopenia?
A. Fragmented Red Blood Cells ( Schistocytes)
B. Decreased Fibrinogen and Increased D-dimer
C. Elevated LDH
D. Decreased Reticulocyte count