Case 1

The patient is a 47-year-old female with a history of coronary artery disease, hypertension, asthma, diabetes and obstructive sleep apnea who presented to an outside hospital with shortnessof breath and lethargy. The patient was found to be in diabetic ketoacidosis, which was treated with an insulin drip. She also had a platelet count of 8 x 109/L on initial laboratory studies. She was presumed to have immune thrombocytopenic purpura(ITP) and treated with five days of intravenous immunoglobulin(IVIG) without improvement. She was transferred to Thomas Jefferson University Hospital for further management.