ABC is a 70-year-old Hispanic female who was referred to the ED by her ophthalmologist for an acute onset of thrombocytopenia. The ophthalmologist...

Ms. ABC is a 70-year-old Hispanic female who was referred to the ED by her ophthalmologistfor an acute onset of thrombocytopenia. The ophthalmologist is treating her for an anteriorscleritis and ulcerative keratitis in the right eye with prednisone, Vigamox, erythromycinointment and weekly methotrexate. The ophthalmologist informed the ED physician that thepatient was coming in with a thrombocytopenia of 6,000 secondary to methotrexate toxicity, thathematology would need to treat the toxicity and that she needed a platelet transfusion. The EDphysician relays this information to you, the admitting nurse practitioner, and states he hasconsented the patient and written orders for a platelet transfusion. Upon seeing Ms. ABC, younote that she was started on methotrexate approximately 6 weeks ago, but has been off themedication for 2 weeks, and just got it refilled yesterday at her appointment with hisophthalmologist which is when labs were completed. She took a dose of methotrexate last night(after labs were done). She has not had any overt signs of bleeding. She was recently diagnosedwith diabetes mellitus type 2 secondary to steroid therapy. She endorses a history of a weightloss of 151bs in last two weeks, decrease vision in the right eye, polyuria, and polydipsia.Current medications: prednisone 20mg BID, methotrexate 20mg every week, Zantac 150mgBID, Vigamox 0.5% ophthalmic 1 gtt BID in right eye, erythromycin 0.5% ophthalmic ointmentto the right eye at bedtime, ibuprofen PRN, folic acid 1mg daily, metformin 750mg dailyPhysical Exam: VS stable, examination negative (skin, heart, lungs, abdomen, rectal, stool foroccult blood is negative). Has some scattered petechiae.LabResultSodium125 mEq/LPotassium4.2 mEq/LCO220 mEq/L (mmol/L)Calcium9.4 mg/dLCreatinine0.9 mg/dIBUN20 mg/dLGlucose573 mg/dLAlbumin3.6 g/dLAST16 units/LALT33 units/LWBC8,000Hematocrit39%Hemoglobin13 g/dLMCV92.8 fLPlatelets7,000/mm-