Terry Gernsheimer, MD, and Michele B. Frank, MD
Dr. Gernsheimer: Puget Sound Blood Center and University of Washington School of Medicine, Seattle, WA
Dr. Frank: Cascade Cancer Center, Kirkland, WA
Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.
This case was reviewed and updated in January 2011 by Dr. Alvin H. Schmaier and members of the Teaching Cases Subcommittee.
23-year-old female aeronautical engineer complains of a rash on her ankles and shins, and easy bruising for 10 days. The rash is not itchy or painful. She denies recent contact with new soaps or detergents. The bruises occur on her arms and sides, unrelated to trauma.
On further questioning, she reports nosebleeds, gum bleeding with flossing, and an unusually heavy menses one week ago. She had an upper respiratory infection 3 weeks ago, which has now resolved. On physical exam, she has no lymphadenopathy or hepatosplenomegaly. Her stool is guaiac positive.
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