A 76-year-old man presents with a complaint of headache, which began several hours after a fall and has steadily worsened. His history is notable for hypertension and coronary artery disease, status post-bypass grafting 4 years prior. He denies any history of bleeding or thrombosis other than his previous coronary symptoms. Medications include a cholesterol-lowering agent, beta-blocker; and a daily aspirin. Examination is notable for a tender bruise over the left occipital region. The remainder of the examination is benign. CBC: Hemoglobin/hematocrit – 13 g/dU39% MCV – 94 fL MCH – 31 pg MCHC – 32 g/dL RDW-CV – I I% White blood cell count – 8,500/-tL Platelet count – 3 I 0,000/-tL
BLOOD SMEAR MORPHOLOGY
Normocytic, normochromic with no aniso- or poikilocytosis or polychromasia. White blood cells are normal and platelets are numerous with normal morphology. PT = 1 2.6 seconds (< 14=”” seconds)=”” inr=”1.1″>< 1=”” .3)=”” ptt=”31″ seconds=”” (22-35=”” seconds)=””>
Questions
• Given the risk of an intracranial hemorrhage, do these laboratory results rule out a coagulopathy?
• What other test{s) might be in order?
