Case Study #2-7 A 36-year-old man was admitted to hospital after sustaining multiple fractures to the lower extremities by jumping from a three-story building in a suicide attempt. His fractures required surgical repair. He has no significant medical history. Current medications include morphine for pain and subcutaneous heparin for prophylaxis against deep venous thrombosis. Consultation with a hematologist is requested because of a dropping platelet count. On physical examination, the patient has multiple bruises, and his lower extremities are cast bilaterally. The examination is otherwise normal. Laboratory tests from the last several days reveal a platelet count that has dropped from 170,000/μL on admission to 30,000/μL 5 days later. Questions: 1. What is the most likely cause of this man’s thrombocytopenia? 2. By what mechanisms does heparin sometimes cause thrombocytopenia? 3. What are the possible clinical consequences of this patient’s thrombocytopenia?
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