Contributed by David Cohen, PSF, MS4; Milon Amin, MD; and Jay S. Raval, MD
This 55 year-old gentleman is status-post laryngectomy for squamous cell carcinoma of the larynx diagnosed in 2010, complicated by a tracheostomy occlusion, leading to cardiopulmonary arrest and subsequent hypoxic brain injury. He was admitted with new-onset altered mental status, after weakness for approximately 6 months. On admission he was found to be severely malnourished.
During his hospital course, thrombocytopenia and acute kidney injury were noted. A renal biopsy showed thrombotic microangiopathy. His blood cultures were positive for Salmonella. On day 4 of admission, he developed hemoptysis and a thick, bloody drainage from his tracheostomy. He was subsequently transferred to the MICU. His platelet level was 89,000/cu mm (reference range: 156,000 - 369,000 / cu mm). His B-type natriuretic peptide level was 2860 pg/mL. His peripheral blood smear is shown below (Image 1).
At this point, what hematologic condition must be considered in the list of underlying conditions for this patient?