MRCP2-2239

MRCP2-2239

A 42-year-old woman presents to her primary care physician with a 10-day history of intermittent nosebleeds. She has never experienced this before, but now reports that even after blowing her nose, the bleeding persists for 2-3 minutes. She has a medical history of hypothyroidism and takes levothyroxine 75 micrograms daily. She recently recovered from the flu but has had no other illnesses.

During the examination, the patient’s vital signs are stable, and there are no abnormalities in her chest or abdomen. However, there are multiple bruises and petechiae on her lower limbs and trunk.

The following investigations were conducted:

– Hemoglobin: 116 g/L (normal range for females: 115-160 g/L)
– Platelets: 16 * 109/L (normal range: 150-400 * 109/L)
– White blood cells: 5.1 * 109/L (normal range: 4.0-11.0 * 109/L)
– Sodium: 136 mmol/L (normal range: 135-145 mmol/L)
– Potassium: 3.5 mmol/L (normal range: 3.5-5.0 mmol/L)
– Urea: 5.0 mmol/L (normal range: 2.0-7.0 mmol/L)
– Creatinine: 61 µmol/L (normal range: 55-120 µmol/L)
– Prothrombin time (PT): 12 secs (normal range: 10-14 secs)
– Activated partial thromboplastin time (APTT): 28 secs (normal range: 25-35 secs)
– Fibrinogen: 2.6 g/L (normal range: 2-4 g/L)
– D-Dimer: 254 ng/mL (normal range: < 400 ng/mL) What is the most appropriate next step in managing this patient?