The patient is a 68 year-old woman with a background history of type I diabetes (on an insulin pump), hypertension, hyperlipidemia and symptomatic multivessel coronary artery disease who was admitted to the hospital for elective coronary bypass surgery, which she had 13 days earlier. She denies a history or present symptoms of splenectomy, iron deficiency, hemolysis, blood loss, chronic infection or inflammatory disorder. She does not experience a burning sensation in her hands or feet. She denies pruritis, weight loss, night sweats, fever, change in vision, or headache. There is no past history of blood clots. There is no history of prior surgery. In addition to insulin, her home medications included metoprolol, atorvastatin and low dose aspirin. She underwent coronary artery bypass graft x 4 on the day of admission. Her platelet count was normal on admission. You are called to see her on postop day 13 for her platelet count of 1006 x 109/L.

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