Q. A 34-year-old female patient presents to the emergency department with generalized weakness, fatigue, and pallor for the past two weeks. She also complains of experiencing frequent episodes of epistaxis over the past week. She denies any history of bleeding disorders in her family or significant medical history. Her only medication is a combined oral contraceptive pill she has been taking for the past ten years. On physical examination, she appears pale and anxious.
Her vital signs are stable. Examination reveals a few scattered petechiae on her lower limbs. There are no signs of organomegaly or lymphadenopathy. The laboratory findings show that hemoglobin is 7.2 g/dL, white blood cell count is 7,500 cells/microliter, and platelet count is 50,000 cells/microliter. The peripheral blood smear shows schistocytes. Her lactate dehydrogenase (LDH) is 800 U/L. The reticulocyte count is 7%. Her coagulation profile, including PT and aPTT, is within normal limits. Serum creatinine is 1.3 mg/dL, and serum haptoglobin is low. Her stool occult blood test is positive.
What is the most appropriate next step in the management of this patient?