A previously healthy 32 year old man presented to an emergency room with malaise, fever, crampy abdominal pain and diarrhea x 2 days, and bloody stools x 1 day. His CBC showed a WBC of 14,000, Hgb 16.4, platelets 206,000, creatinine 0.9, LFTs normal. He had various cultures done and was given ciprofloxacin x 5 days. One week later he presented with weakness and lightheadedness, such that he had trouble getting out of bed. He had continued to note bloody stools. His temperature was 102.7 F and he was icteric. He was anemic and thrombocytopenic and was given two units of PRBC prior to transfer here. Serum creatinine was 2.2.

Past History: He had an episode of severe gastroenteritis as a child that required hospitalization. He had a peritonsillar abscess drained as an adolescent.

Medications: Vicodin p.r.n. and pantoprazole.

Family Hx: Father with cerebral aneurysm, HTN. Mother A&W. Maternal grandfather with lung CA. Maternal grandmother and paternal grandfather with MI.

Social Hx: Married, no children. Desk job. Quit smoking 3 mo ago, 2-3 beers per night. No illicit drugs. No pets.

Physical examination: Temperature 37.8 C, other vitals normal, SaO2 98% on RA. Alert and oriented. Not icteric. No focal neuro deficits. No bruises or petechiae. Exam otherwise normal.

TEST MENU

 

CBC and differential

Retic count

Blood smear

 

INR

aPTT

 

Bone marrow biopsy

 

Iron/TIBC

Ferritin

B-12

Folate

 

ESR

Coombs test

Hemoglobin electrophoresis

Hemoglobin A2

Haptoglobin

Osmotic fragility

G6PD

EPO

 

Thrombin time

Platelet function screen

Platelet aggregometry

Bleeding time

Fibrinogen

D-dimer

Fibrin monomer

Factor II, X, V, VII, IX, VIII, XI, XII, XIII

Protein C

Protein S

Antithrombin

Activated protein C resistance

Factor V Leiden

Prothrombin gene mutation

Inhibitor screen

ADAMTS-13

 

SPEP

Serum immunofixation

UPEP

Urine immunofixation

Quantitative immunoglobulins

Serum viscosity

 

 

Lytes, glucose, creat, BUN

AST, ALT

Alk phos, GGT, bili

Calcium

LDH

CRP

Uric acid

Albumin, total protein

 

Urinalysis

Urine hemosiderin

 

Chest xray

Skeletal survey

BodyCT

V/Q scan

Helical chest CT

Other radiology

 

Other pathology (biopsy)

Culture results