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.