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history A 36-year-old woman presents to her general practitioner (GP) complaining of spontaneous bruising mainly on her legs. The bruising has been noticeable over the last 4–6 weeks. She cannot remember any episodes of trauma. In addition, her last two menstrual periods have been abnormally heavy, and she has suffered a major nosebleed. She otherwise feels well and is working full time as a secretary. There is no significant past medical history. She is married with one daughter aged 11 years. There is no family history of a bleeding disorder. She is a non-smoker and drinks a small amount of alcohol socially. Examination On examination, there are multiple areas of purpura on her legs and to a lesser extent on her abdomen and arms. The purpuric lesions vary in color from black–purple to yellow. There are no signs of anemia, but there are two bullae in the mouth and there is spontaneous bleeding from the gums. There are no retinal hemorrhages on funduscopy. Blood pressure is 118/7

History A 66-year-old woman, a retired nurse, consults her general practitioner (GP) with a 4-month history of tiredness, slight breathlessness on exertion and loss of weight from 71 to 65 kg. Her appetite is unchanged and normal, she has no nausea or vomiting, but over the last 2 months she has had an altered bowel habit with constipation alternating with her usual and normal pattern. She has not seen any blood in her faeces and has had no abdominal pain. There is no relevant past or family history, and she is on no medication. She has smoked 20 cigarettes daily for 48 years and drinks 20–28 units of alcohol a week. Examination She has slight pallor but otherwise looks well. No lymphadenopathy is detected, and her breasts, thyroid, heart, chest and abdomen, including rectal examination, are all normal. The blood pressure is 148/90 mmHg. Questions • What is the likeliest diagnosis? • How would you investigate the patien