A 45-year-old man with coronary artery disease underwent cardiac catheterization and stenting of the left anterior descending artery with initiation of clopidogrel (Plavix) in addition to metoprolol, lisinopril, and pravastatin. He now presents for evaluation of thrombocytopenia and renal failure. His family says that he is a little confused. He also has been fatigued and looks pale. He has a slight fever that is accompanied by headaches. On examination, his vital signs are normal. He has purpuric lesions on his lower extremities.
Blood chemistry:
Sodium, 140 mmol/L
Potassium, 5.2 mmol/L
Chloride, 104 mmol/L
Total CO2, 26 mmol/L
Urea nitrogen, 30 mg/dL
(10.7 mmol/L)
Creatinine, 2.0 mg/dL
(177 mcmol/L)
Glucose, 100 mg/dL (5.6 mmol/L)
Coombs test, negative
Prothrombin time, 11 s
Partial thromboplastin
time, 30 s
Urinalysis:
Color, yellow
pH, 5.5
Specific gravity, 1.025
Protein, 2+
Blood, 3+
Glucose, negative
Ketones, 1+
Bilirubin, 2+
Urobilinogen, 2+
WBCs, 2/hpf
RBCs, 10/hpf
Bacteria, none
Complete blood count:
White blood cells, 12,000/mm3
Hemoglobin, 9 g/dL (90 g/L)
Hematocrit, 27 g/dL
Platelets, 40,000/mm3
Schistocytes, prominent
Reticulocyte count, 3%
LDH, 200 U/L (elevated)
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