{"ops":[{"insert":"A 24 year old woman presents with jaundice and abdominal pain for 1 day. The pain is mild and diffuse, and aching in nature.\n\nShe has also experienced intermittent episodes of dark colored urine for 7 days. On the 2nd such day, she was evaluated by her primary care practitioner, who found no abnormal clinical findings.\n\nAt that time, a complete blood cell count, urinalysis, renal profile and renal ultrasound were all normal.\n\nThere is no history of renal stones, NSAID abuse, weight loss, night sweats, fever, malena, hemoptysis or pale stools.\n\nHer menstrual cycles are regular, and 30 days in length. The last period was 2 week ago; a urine pregnancy test is found to be negative.\n\nHer medical, surgical and drug histories are unremarkable. There is no family history of bleeding disorders. She neither smokes nor consumes alcohol.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-114_en.png"}},{"insert":"\n"}]}
2
Investigate
Repeat Complete Blood Count
{"ops":[{"insert":"RBC: 1.6x10^6\/mm3 (3.9x10^6-5.0x10^6)\nHb: 5 g\/dL (11-18)\nHct: 17.2%\nMCV: 75 fl (75-95)\nRDW: 28 (11.6-14.6)\nReticulocyte count: 10.9% (0.5-2.3)\nWBC: 3,600\/mm3 (3,500-10,500)\nPlt: 189,000\/mm3 (150,000-450,000)\n\nThe peripheral smear reveals hypochromic red blood cells, polychromatophilia and normoblasts. The other cell lines appear normal.\n"}]}
Repeat Urinalysis
{"ops":[{"insert":"Color: Dark\nMicroscopy of centrifuged sediment: no erythrocytes\nDipstick test: positive for heme\n"}]}