A 51 year old man presents with spontaneous bleeding from his mouth for 2 days, along with passage of tarry black stools for a week. There is no history of epistaxis, hemoptysis, hematemesis, hematuria, or recent infection. He denies experiencing joint pain or tenderness. His medical and surgical histories are unremarkable and he is not on any drugs currently. There is no history of transfusion of blood or blood products. Nor is there a family history of bleeding disorders. He does not smoke, and is a life-long teetotaler.
RBC: 4.45x10^6/mm3 (4.32-5.72x10^6) Hb: 13.9 g/dL (13.5-16.5) Hct: 42% (41.0-50.0) MCV: 94 f/L (80-100) MCHC: 33% (31-37) WBC: 6,800/mm3 (5,000-10,500) Plt: 18,000/mm3 (150,000-400,000) The peripheral smear reveals normocytic normochromic red blood cells with normal white blood cells. There is an inadequate number of platelets. immature forms are present.
aPTT: 29s (control: 30s) PT: 16s (control: 17s) Clotting time: 5 min (1-9)
The marrow is normocellular, with an adequate number of megakaryocytes. There is normal myeloid and erythroid proliferation. No abnormal cells or significant dysplasia are seen. The myeloid:erythroid ratio is 6:1
HIV Antibodies: negative