Case History

Case number: 00002

A middle-aged male was admitted for two weeks of dyspnoea and chest discomfort. His past medical history is unremarkable save for hypertension. On admission, he is noted to have thrombocytopaenia with a platelet count of 23. You are asked to evaluate his thrombocytopaenia.

Prior to this admission, he has been well with no bleeding symptoms. He has no other symptoms, and has not taken any medication / traditional remedies recently. He denies diarrhoea. Aside from a BP of 181/109 (max 240/150), there are no abnormalities on physical examination.

Hb 9.2 (MCV 90.7) < 14.4 (five years ago)
Plt 116 < 260 (five years ago)
Cr 357 < 64 (five years ago)
LDH 1500
CXR no obvious lung masses

His peripheral blood film is shown below:


  1. What does the PBF show?
  2. What is the most likely diagnosis?
  3. What investigations would you order for this patient?
  4. How would you manage this patient, and why?