An 89-year-old man complains of blood in his stool intermittently

An 89-year-old man presents to you complaining of blood in his stool intermittently over the past 6 months. He reports an unintentional 20-kg weight loss during that time. He has not been to the doctor in more than 20 years and is taking no medications.

Vital signs are: temperature 37.1 °C, blood pressure 122/72 mm Hg, pulse 77 beats/minute, and respiratory rate 15 breaths/minute. He appears cachectic.

His complete blood count shows a white blood cell count of 11,000/mm3, his hemoglobin level is 11 mg/dL, and his platelet count is 133,000/mm3.

Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are normal. D-dimer is elevated.

Which of the following is the most likely diagnosis?

• acute disseminated intravascular coagulation (DIC)
• heparin-induced thrombocytopenia (HIT)
• thrombotic thrombocytopenic purpura (TTP)
• malignancy and chronic disseminated intravascular coagulation (DIC)

This question appears in Med-Challenger Family Nurse Practitioner Exam Review with CME

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