A 25 year old female medical student is found to be anemic by her gynecologist. Her Hgb is 7.0 g/dl, Hct is 21%, and her MCV is 60. She reports heavy menstrual bleeding throughout her life. She also complains of epistaxis and a "funny rash" on her lower extremities whenever she takes aspirin. Her mother needed several transfusions with delivery of each of her children.
Does this patient have a coagulation abnormality?
What disease(s) are you suspicious for?
What should be your next test?
How would you confirm your diagnosis?
How would you treat this patient?
A 3 year old boy presents with a painful left elbow after mild trauma. Evaluation reveals a hemarthrosis. The child is adopted so no family history is available. The patients mother reports no other problems with the child. A PT is normal, an aPTT is prolonged.
How would you work this patient up further?
Discuss the genetics of the disease.
Discuss therapy of this disorder.
You are working at the VA hospital when a 45 year old veteran comes to the emergency room complaining of "vomiting up blood." The patient reports a long history of ethanol abuse drinking up to one quart of vodka and two six packs of beer daily for the past 8 years. After stabilizing the patient and awaiting evaluation from the GI service, his coagulation tests appear on the computer. His PT is elevated at 16 seconds and his aPTT is slightly elevated as well.
What disorders are in your differential diagnosis?
Are there any other laboratory values you would like?
How would you manage this patient acutely?
How would you manage this patient chronically?
A previously healthy 55 year old woman present for a routine rhinoplasty. She has had 2 previous cesarean sections and several dental procedures without bleeding complications. You are called by her surgeon preoperatively to evaluate her coagulation test which reveal a normal PT and an elevated aPTT of 42 seconds.
How would you proceed?
What are some likely etiologies for her abnormal lab values?
Would a bleeding time be helpful?