A 57-year-old retail pharmacist presented to his primary care physician because of progressive headaches, blurry vision, hearing loss, and episodes of confusion. He had not had night sweats, fever, or weight loss. On physical examination he was found to be pale and there were ecchymoses over his upper and lower extremities that he reported occurred spontaneously over the past 3 months. He had attributed these to his current medications including both aspirin (81 mg/day) and clopidogrel (75 mg/day), although he had been taking these medications for more than 5 years without noticing ecchymoses in the past. He did not have palpable lymphadenopathy nor was there splenomegaly.