Question

A 58-year-old man is admitted to the hospital with jaundice and nosebleeds.

CBC and WBC differential counts:

WBC: 9.5                                        Band neutrophils: 15

RBC: 3.10                                       Segmented neutrophils: 50

Hgb: 10.4                                        Lymphocytes: 25

Hct: 32.0                                         Monocytes: 8

MCV: 103.1                                    Eosinophils:

MCH: 33.5                                      Basophils:

MCHC: 32.5                                   Metamyelocytes: 2

RDW: 12.9                                      Myelocytes:

PLT: 119.9                                      Promyelocytes:

PT: 16 sec

aPTT: 53 sec

Direct bilirubin: increased

ALT: elevated

AST: elevated

ALP: elevated

1. Interpret the coagulation screening test.
2. Based on all the data provided, what condition is most likely?
3. What information is most diagnostic?
4. What physiologic abnormality most likely underlies the nosebleeds?

Answer 1

The blood clotting parameter values of the patient and the normal values are given below:

Blood clotting parameter	Normal range	Patient’s value
PTT (Partial thromboplastin time)	25-35 seconds Panic: ≥ 60 seconds	53 sec
PT (Prothrombin time)	11-15 seconds Panic: ≥ 30 seconds	16 sec

The increased PTT level and PT level indicate that the patient had a prolonged bleeding time. The reduced platelet levels (normal range is, 150,000 – 450,000/mm³) also explain the poor blood clotting in the given patient.

The increased levels of direct bilirubin, ALT, ASP, and ALP suggest reduced liver functioning. These results are very informative regarding the liver functioning.

All the clotting factors are synthesized in the liver. Reduced liver functionality, thus, the reduced synthesis of coagulation proteins is the underlying cause of nose bleeds in the given patient.