Hematology
During the second admission, when the patient first presented with seizures there was suspicion for thrombotic microangiopathy possibly due to severe hypertension, ITP, or thrombotic thrombocytopenic purpura (TTP). Platelet count was 58,000 and lactate dehydrogenase was 359 but trended down. He had a negative thrombotic work-up (Table 1) consisting of normal ADAMTS13 activity, negative direct antiglobulin test, normal serum C4, normal serum C3, parasite smear, and iron studies. Lab results were notable for a high reticulocyte count and low haptoglobin suggestive of hemolysis. The hepatitis panel was negative on multiple occasions. Prior to discharge his platelet level stabilized and he was asymptomatic where we ultimately came to a diagnosis of thrombotic microangiopathy secondary to HTN.