Case 1-2007: A 40-year-old woman with epistaxis, hematemesis, and altered mental status

A 40-year-old woman was admitted to this hospital with epistaxis, hematemesis, and altered mental status. The patient had had heavy menstrual bleeding for 6 months, but bleeding developed at other sites 2 weeks before admission. She had no personal or family history of a bleeding disorder. On admission to this hospital, she had evidence of both bleeding and thrombosis; the laboratory evaluation showed markedly abnormal coagulation studies and a low-normal platelet count. On the 10th hospital day, the results of a diagnostic test were reported.