Complete blood count with differential, platelet count, and blood smear |
Polycythemia or anemia, granulocytosis, thrombocytosis, poikilocytosis
|
Evidence of red cell fragmentation (schistocytes) and microangiopathy, consider:
|
Thrombocytopenia, consider:
|
Severe neutropenia
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Eosinophilia
|
Partial thromboplastin time |
Minimally prolonged in TTP-hemolytic uremic syndrome |
Prolonged in purpura fulminans and DIC |
Prolonged if lupus anticoagulant activity present, and assay sensitive |
Cryoglobulins (occasionally cryofibrinogen and cold agglutinins) when location and history suggest cold occlusion syndrome |
Biopsy |
Confirms occlusion versus other mechanisms of vessel injury |
May suggest platelet plugs instead of fibrin thrombi |
May suggest cryoglobulin gelling |
May diagnose calciphylaxis |
May suggest cholesterol, oxalate, or crystal globulin occlusion |
Special stains for organisms in immunocompromised hosts, when appropriate |
Basic hepatic and renal function screens |
Hepatic function can affect vitamin K-dependent factors and warfarin metabolism |
Renal disease moves cutaneous calciphylaxis higher in the differential diagnosis |
ANCA |
To reduce the likelihood of the uncommon noninflammatory retiform purpura presentation of granulomatosis with polyangiitis (Wegener's granulomatosis) or microscopic polyangiitis |
ANCA may be available before permanent histologic sections |
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