A 56-year-old man with diabetes mellitus presented to his primary care physician complaining of bleeding gums. He reported gingival bleeding after brushing his teeth without epistaxis, hematuria, ecchymosis, or melena. His only medication was metformin, and he denied family history of bleeding disorders or malignancy. Vital signs were stable. Physical examination was without lymphadenopathy, hepatosplenomegaly, petechiae, or ecchymosis. Laboratory studies revealed an isolated thrombocytopenia of 59 × 109/L (reference range, 150-400 × 109/L [to convert to ×103/μL, divide by 1.0]) without anemia or leukopenia. There was no platelet clumping or abnormal platelet morphology on peripheral blood smear. White blood cell and red blood cell morphology were normal.
Wolfe HR, Bhushan M, Choi S. Treatment of Immune Thrombocytopenia: A Teachable Moment. JAMA Intern Med. 2018;178(3):406–407. doi:10.1001/jamainternmed.2017.7614
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