Question

• 15-year-old male, Mohammed, from Saudi Arabia - Admitted to the ER after automobile accident . Several superficial cuts and bruises on head and arms • Bleeding profusely, more bleeding than expected from the nature of his wounds . Consider possible causes of this abnormal bleeding and the lab tests that might be used to differentiate and diagnose the cause. • Petechiae were noted on Mohammed's extremities. Blood work was ordered Laboratory Studies Hematology WBC 10.5 x 10°/L RBC 2.3 X 10'/L Hb 66 g/L Het 0.193 L/L Plt count 133 x 109/L Hemostasis PT 11.2 sec APTT 25.6 sec

Answer 1

15 yr old Mohammed :

Causes for abnormal bleeding :

1.) Hemophilia

2.) Leukemia

3.) Liver disease

4.) Clotting factor deficiency

5.) Thrombocytopenia

6.) Von willibrand disease

7.) Vitamin K deficiency

Lab tests :

1.) Platelet count

2.) Hemoglobin

3.) Peripheral smear

4.) Bone marrow examination

5.) Bleeding time

6.) Clotting time

7.) Prothrombin time

8.) Activated partial thromboplastin time

9.) vWF assay

Question 6:

Mohammed's condition will most likely be Inherited, as most of the abnormal bleeding disorders are inherited, and also, he gives a history or repeated petechia and bruises and bleeding since childhood. Hence, it is inherited

Question 7:

Platelet function tests measure ability of platelets to aggregate and promote clotting. They help to identify and diagnose platelet dysfunction in those with a history of excessive bleeding. It can detect inherited and acquired platelet dysfunction.

Question 8:

Mohammed is most likely suffering from Von Willibrand disease. Increased bleeding time and clotting time with abnormal ristocetin confirms the diagnosis as vonWillibrand disease

Question 9:

Other tests - Activated partial thromboplastin time (APTT), Prothrombin time (PT), vWF plasma levels, Tourniquet test, Factor VIII assay.

14.) 23 year old man

Q1- platelet count is decreased, presence of Thrombocytopenia. But MPV ( mean platelet volume) is increased due to abnormal increase in size of platelets. They are called Giant platelets.

Q2- most likely inherited conditions - Bernard soulier syndrome or May hegglin anomaly. They are giant platelet diseases with thrombocytopenia and increased Mean Platelet Volume and adequate expression of CD41, CD61 and CD42b. Confirmed by Flow Cytometry.