November 2015 - Presented by Dr. Adam Stelling



The patient is a 6-year-old boy who presented with 4 days of vomiting and bloody diarrhea.  Significant exposures included recent consumption of unpasteurized apple cider. Despite receiving IV fluids he became oliguric and developed mild edema in the face and extremities. Labs were drawn, a stool sample was sent for culture, and a peripheral blood smear was reviewed.

Microscopic Description:

The peripheral blood smear shows normochromic anemia with frequent schistocytes. Polychromasia is slightly increased. The leukocytes are normal while the platelets are decreased with normal morphology.


Picture 1   Picture 2



Hct: 25.3
Plt: 58
Cr: 2.31
aPTT: 26.2
INR: 0.97
Stool Culture: E. Coli 0157:H7 positive for shiga-toxin 2

All of the following diagnoses are associated with schistocytes; however, which one best fits this case.

a.  Thrombotic Thrombocytopenic Purpura

b.  Disseminated Intravascular Coagulation

c.  Systemic Lupus Erythematosus

d.  Hemolytic Uremic Syndrome