Pe

Labs Imaging Gross Pathology Micro Pathology Treatment

Discussion

A 28-year-old male conies to his family medicine clinic and complains of increased bruising over the past three days, as well as bleeding from die gums while brushing his teeth.

The patient is an amaceur weight lifter who recently tried to lift an excessive amount of weight but strained a muscle and has been taking indomethacin for pain.

VS: normal. PE: athletic male with significant ecchymoses on chest and legs bilaterally; blood pressure cuff leaves petechial lines on arms; blood sample site taken on his arrival for routine blood work has become a large ecchymosis.

CBC/Lytes/UA: normal. LFTs normal; increased PT.

Discontinue indomethacin. Vitamin K may be used in patients with an elevated PT.

NSAlDs are extensively metabolized and protein-hound. NSAlDs inhibit the enzyme cyclooxygenase, thereby inhibiting prostaglandin production, which in turn produces their antipyretic, anti-inflammatory, and analgesic effects. Aspirin in particular is an irreversible inhibitor, and therefore the production of new platelets (about eight days) is required before its anticlotting effects can be reversed. Moderate doses of N SAlDs can bring out subclinical platelet defects in otherwise healthy individuals.

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