Ashton is 1 -year old male. Presented in emergency room with recent onset of easy bruising, bleeding gums, and persistent epistaxis. Previously in excellent health. Mother stated he was "never sick before in his entire life." No history of recent viral infection, and no family history of bleeding disorders. Physical Exam Bleeding from the left nost

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Ashton is 1 -year old male. Presented in emergency room with recent onset of easy bruising, bleeding gums, and persistent epistaxis. Previously in excellent health. Mother stated he was "never sick before in his entire life." No history of recent viral infection, and no family history of bleeding disorders. Physical Exam Bleeding from the left nostril. Numerous petechiae and purpura; mostly on the extremities. No organomegaly. CBC (with microscopic differential) RBC

,4.52\times (10^(12))/(L)

HGB,13.4(g)/(d)L

HCT

,37.2%

MCV

,82.3fL

MCH

,29.6pg

MCHC

,35.9(g)/(d)L

RDW

,12.1

WBC

,5.3\times (10^(9))/(L)

N,44%

L,39

M

,14

E

,1

B 2 PLT

,<5,\times (10^(9))/(L)

MPV

,10.9fL

Found on Differential a. What morphologic alterations are seen in this blood smear field? b. What further laboratory studies, if any, are indicated? c. what is the most likely diagnosis?

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