Correct!
5. 3 and 4
He has risk factors for thrombotic thrombocytopenic purpura/hemolytic uremia syndrome (TTP/HUS) given his history of renal transplant with a tacrolimus side effect and having an underlying malignancy although adenocarcinoma is the more typical malignancy associated with TTP/HUS. He may also have developed an acquired ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13-also known as von Willebrand factor-cleaving protease) deficiency. In addition, he is at risk for medication induced thrombocytopenia from bone marrow suppression with use of trimethoprim/sulfamethoxazole, tacrolimus and mycophenolate. The ADAMTS13 level was within normal range, not <5% which would be associated with acquired TTP. His peripheral smear showed a few schistocytes but not enough to diagnose a microangiopathic hemolytic process. His thrombocytopenia was determined to be drug related bone marrow suppression and his counts eventually improved without intervention.
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