DiscussionTwo weeks before admission after an exacerbation of peptic symptoms, a gastroscopy showed extensive erosive biliary gastritis, with fresh blood loss. A full blood count at that time was normal: Hb 14-0 g/dl; WBC 7.5X 10'/l; and platelets 350x 109/l. De-Nol (two tablets tid) was prescribed. He was taking no other medications.On admission he was apyrexial and had evidence of widespread bleeding: oral haemorrhagic vesicles; widespread petechiae; epistaxes; melaena and fresh blood per rectum; and microscopic haematuria. A full blood count revealed severe thrombocytopenia: the platelet count was <10x 109/l. The remainder of his FBC was normal (Hb 14*3 g/dl, WBC 9-0x 109/1).Morphology of the blood film, full coagulation screen, and biochemical profile (electrolytes, LFTs) were also normal. Acute and convalescent viral titres
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