History A 68-year-old woman presents to her general practitioner complaining of spontaneous bruising mainly on her legs. The bruising has been noticeable over the last 3 weeks. She cannot remember any episodes of trauma. She has suffered a major nosebleed. She feels very tired and has noticed shortness of breath on exertion. There is no significant past medical history. There is no family history of a bleeding disorder.
She is a non-smoker and drinks a small amount of alcohol socially. Examination On examination, there are multiple areas of purpura on her legs and to a lesser extent on her abdomen and arms. The purpuric lesions vary in color from black–purple to yellow. She is pale with conjunctival pallor. There are two bullae in the mouth, and there is spontaneous bleeding from the gums. There are multiple small retinal hemorrhages on fundoscopy. Blood pressure is 118/72 mmHg.…
