Case Presentation: A previously healthy 57-year-old man with a history of chronic sinusitis who received the Ad26.COV2.S vaccination 13 days ago without incident presented to the ED with left lower extremity swelling and pain, left medial thigh ecchymosis, transient episodes of right hand paresthesia and weakness, severe headache with transient blurry vision, and progressively worsening [...]

Background: The current American Society of Hematology (ASH) guideline recommends the use of thrombopoietin receptor agonists, eltrombopag or romiplostim as one of the second-line therapies for chronic immune thrombocytopenia (ITP). The efficacy and safety of those drugs have been tested in several clinical trials. However, the safety profile was not consistent throughout trials and is [...]

Background: Heparin-induced thrombocytopenia (HIT) syndrome is an immune-mediated disorder producing thrombocytopenia and thrombosis, with or without prior exposure to heparin. Although avoidance of heparin products and non-heparin anticoagulants are used, immune-based therapies including intravenous immunoglobulin have been tried when the thrombocytopenia persists or there is breakthrough thrombosis. We sought to systematically review and analyze the [...]

Background: Heparin-Induced Thrombocytopenia (HIT) is an antibody-mediated pro-thrombotic disorder which occurs after exposure to heparin product. Diagnosis of HIT type II is rather challenging as affected individual often has other causes of thrombocytopenia and a delayed discontinuation of heparin in HIT type II is associated with a mortality rate of 20-30%. 4Ts score is a [...]

Background: Heparin-Induced Thrombocytopenia (HIT) is a rare (0.1-1% of heparinized medical patients) but devastating (up to 10% mortality) side-effect of heparin administration[1].  In thrombocytopenic patients, the pre-test probability of HIT is estimated by the validated “4Ts Score”, which is used to risk-stratify patients into Low (0-3 points), Intermediate (4-5 points), and High (6-8 points) likelihoods [...]

Case Presentation: A 61 years old man with a history of metastatic rectal carcinoma T3 N0 M1 underwent neoadjuvant & adjuvant chemotherapy with FOLFOX along with resection of rectal tumor. One year later he had recurrent liver & sacral metastases for which he was started on FOLFIRI and bevacizumab with completion of 1 cycle of [...]

Case Presentation: A 3,400 gram male infant was born at full term to a 32 year old G1P0>1 mother with unremarkable prenatal labs. Labor was complicated by prolonged rupture of membranes, foul smelling amniotic fluid, and maternal fever of 100.5°F. The infant was delivered vaginally. After initial resuscitation, the infant was started on antibiotics due [...]

Case Presentation: A 67-year-old male was hospitalized for right lower extremity skin abscess with cellulitis complicated by methicillin sensitive Staphylococcus Aureusbacteremia. The patient received piperacillin/tazobactam (pip/taz) and vancomycin over the first 5 days of hospitalization which was de-escalated to cefazolin at discharge.   Thirty-six hours after discharge, the patient was readmitted with expanding area of erythema, [...]

Case Presentation: A 71-year-old woman presented with progressive fatigue and two months of dull pain in her proximal extremities. Medical history was significant for depression with psychotic features, well-controlled on fluoxetine and trifluoperazine. Exam demonstrated diffuse non-tender hyperpigmented patches on her back and forearms and proximal extremity tenderness. Labs revealed a hemoglobin (Hb) of 4.1g/dL [...]

Case Presentation: A 24-year-old Caucasian female with a family history of multiple autoimmune disorders presented with 3 weeks of bruising, petechiae, fatigue, and outside labs that revealed significant anemia and thrombocytopenia. Admission workup showed Hgb 7.6, platelets (PLT) < 3,000, and elevated MCV. Further labs showed elevated LDH, indirect bilirubinemia, haptoglobin< 10, and positive DAT [...]