What does the PBF show?
Microangiopathic haemolytic anaemia
What is the most likely diagnosis?
TMA secondary to malignant hypertension
Differentials: TTP / HUS (diagnosis of exclusion), other secondary TMA syndromes (less likely because of normal coagulation, no symptoms of autoimmune disease / malignancy, no drug history)
What investigations would you order for this patient?
PT/APTT, fibrinogen (rule out DIC), consider ADAMSTS13
How would you manage this patient, and why?
Treat the hypertension as that is the reason for TMA. There is no proven benefit of plasma exchange in secondary TMA syndromes (in contrast to primary TTP).