The initial clues to this patient's diagnosis are her altered mental status, fever, and discolored urine. Although laboratory values show anemia and thrombocytopenia, a normal aspartate aminotransferase (AST) makes HELLP syndrome less likely. A normal coagulation profile and fibrinogen suggest an absence of consumptive coagulopathy. In sepsis, a higher white blood cell count or left shift would be expected. Because her creatinine elevation is not marked, HUS is less likely.
Hematology and critical care specialists are immediately consulted. The patient is admitted to the intensive care unit where transfusion of packed red blood cells is begun for her severe anemia.
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