A 56 year-old man arrives to the emergency room with confusion. He is found to have anemia and thrombocytopenia and is referred to you for further evaluation.

You are asked to see a 77 year-old woman who underwent lithotripsy 2 days ago and is now presenting to the emergency department with diaphoresis, tachycardia and hypotension. She is found to have a platelet count of 40 x 109/L. The referring physician would like to know why the patient is thrombocytopenic.

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