A 64 year old lady presents 45 minutes after a generalized tonic-clonic seizure which lasted for approximately 5 minutes. She recovered consciousness immediately afterwards, but has remained drowsy and confused since then. All of this was witnessed by her daughter.

She had complained 'feeling unwell' during the preceding 4 days. Her medical history is only significant for mild hypertension well controlled on Amlodipine alone.

A capillary blood glucose and serum electrolytes are within normal parameters, as are serial ECGs, a noncontrast CT of the brain, and a toxicology screen.

However, a complete blood count is significant for a Hb of 8.7 g/dL (normal:11-18), and platelet count of 40,000/mm3 (normal: 150,000-400,000).

A follow up blood film confirms the presence of anemia and thrombocytopenia, while additionally revealing abundant reticulocytes and numerous schistocytes.