History A 17-year-old girl presents to the general practitioner and complains of spontaneous bruising, especially on her legs, for the last three weeks, and major nosebleed. There were no episodes of trauma She also complains of tiredness and shortness of breath during exertion. Any significant past medical history, as well as family history of any bleeding disorder, is absent. Examination Multiple areas of black–purple to yellow colored purpura were observed on her legs and a few on arms and abdomen. She appears pale with conjunctival pallor.

There are two bullae in the mouth, and there is spontaneous bleeding from the gums. Fundoscopy revealed multiple small retinal hemorrhages. Blood pressure is 118/72 mmHg with normal cardiovascular, abdominal, and respiratory. Investigation Haemoglobin: 5.8 g/dL                                                   (11.7–15.7 g/dL) Mean corpuscular…