A 52-year-old female data entry worker complained of bilateral wrist pain. Her physician prescribed a non-steroidal anti-inflammatory drug. Her wrist pain improved; however, over the next 3 months, she noted increasing fatigue and scattered bruises. Past medical history was normal. She was taking no other medications and had no recent chemical exposure. Physical examination revealed pallor and scattered ecchymoses (skin coloration) with petechiae on her chest and shoulders with no other abnormalities.​