1. History of Present Illness

A 45 y.o. female was referred to a hematologist for evaluation of "easy bruisability." Three weeks prior, while on vacation in Florida, the patient noted a large bruise on the lower medial right thigh which subsequently spread to involve the entire thigh over the next week. She did not notice other bruises or skin changes. The location of the bruise did not coincide with any history of trauma. At that time, she had blood tests revealing the following:

WBC 3300/uL, Hgb 9.5 g/dL, Hct 28.9%, Plt 213,000/uL PT 15.4 sec, PTT 28.0 sec

Five days before seeing the hematologist, she developed fever, 101-103 ÂșC, and intermittent nausea, vomiting, and anorexia.

In the hematologist's office, the patient complained of headache, severe fatigue, dyspnea on exertion, and feeling faint. The patient was pale and orthostatic. Her right leg was swollen from the thigh to the ankle. The skin of the right leg was under pressure and exquisitely painful to touch. A stat CBC showed: Hgb 4.3 g/dL and Hct 14.0%

She was immediately transferred to the emergency room for admission.