Are additional studies warranted for diagnosis or determining therapy?

A 66-year-old man presents with a complaint of bruising and severe pain in the right arm and forearm after painting a wall yesterday. His history is notable for osteoarthritis, hypertension, and non-insulin-dependent diabetes mellitus; he denies any prior history of bleeding. His medications include hydrochlorothiazide and glyburide (a sulfonylurea), and he took ibuprofen for the pain last night. Examination is notable for large ecchymoses over the right shoulder and triceps, with swelling and tenderness of the right forearm and wrist. The remainder of the examination is benign. CBC: Hemoglobin/hematocrit – 13 g/dU39% MCV – 94 fL MCH – 29 pg MCHC – 28 g/dl RDW-CV – I I% WBC count – 1 3,500/Jll Differential: Neutrophils – 45% Lymphocytes – 50% Monocytes – 5% Platelet count – 300,000/Jll Questions PT = 1 2.1 seconds (< 14=”” seconds)=”” inr=”1″ .0=””>< 1=”” .3)=”” ptt=”77″ seconds=”” (22-35=”” seconds)=””>

• Do the CBC and screening coagulation test results point to a specific cause for a bleeding tendency in this patient?

• Are additional studies warranted for diagnosis or determining therapy?

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Based on smear morphology and the red blood cell indices (mean cell volume [MCV], mean cell hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC]), the patient has a severe microcytic, hypochromic anemia most likely caused by iron deficiency (see Chapter 5).

Based on smear morphology and the red blood cell indices (mean cell volume [MCV], mean cell hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC]), the patient has a severe microcytic, hypochromic….

Given the diagnosis of HHT, how should this patient be managed?

The patient's history and physical examination (telangiectasia involving the lips, tongue, and palms) are consistent with a diagnosis of hereditary hemorrhagic telangiectasia (HHT). Three diagnostic criteria are met: multiple telangiectases,….

As this patient with HHT grows older, her bleeding tendency will likely become progressively more difficult to manage.

As this patient with HHT grows older, her bleeding tendency will likely become progressively more difficult to manage. If she were premenopausal, oral contraceptives would be an option, but in….