Question

Bleeding disorder.

A 3-year old girl was brought to A&E by her father. Following a minor fall several hours ago, the child was still bleeding from the mouth. Her father said that she did have a tendency to bleed for longer than expected following immunization. However, there was no history of bruising or haematomas. There was no known family history of a bleeding disorder.

A full blood count, PT AND aPTT were ordered and the result were follows:

Full blood count : WBC: 7.9 X 10^9/L;

RBC: 5.1 X 10^12/L;

HGB: 12.3 g/dL;

HCT: 35.4%;

MCV: 84 fL;

PLT: 350 X 10^9/L;

MPV: 9.4 fL

PT/ INR: 1.1 (0.8- 1.2)

aPTT: 39.0 s (21-35 s)

Blood group (ABO): B

What do these results tell you and why?

What follow up tests should be requested at this time? Explain the reasoning for your selections.

Blood film, PFA-100, PT, aPTT, Thrombin time, Fibrinogen, Mixing test, Factoe assays, Flow cytometry.

Answer 1

A 3-year old girl was brought to A&E by her father. Following a minor fall several hours ago, the child was still bleeding from the mouth. Her father said that she did have a tendency to bleed for longer than expected following immunization. However, there was no history of bruising or haematomas. There was no known family history of a bleeding disorder.

A full blood count, PT AND aPTT were ordered and the result were follows:

Full blood count : WBC: 7.9 X 10^9/L;

RBC: 5.1 X 10^12/L;

HGB: 12.3 g/dL;

HCT: 35.4%;

MCV: 84 fL;

PLT: 350 X 10^9/L;

MPV: 9.4 fL

PT/ INR: 1.1 (0.8- 1.2)

aPTT: 39.0 s (21-35 s)

Blood group (ABO): B

What do these results tell you and why?

What follow up tests should be requested at this time? Explain the reasoning for your selections.

Solution

i) WBC count,RBC,HGB,HCT,MCV,PLT,MPV,PT/INR all are normal. That’s why does not hint about the problem.

The only alarming test is aPTT. aPTT is used with conjunction in PT(Prothrombin Time- which only covers extrinsic pathway for blood coagulation.)

Prolonged aPTT may indicate coagulation factor deficiency (hemophilia) or use of heparin.

As the patient does not present the symptoms of bruising, and family history of bleeding disorder, the problem may not be associated with the platelets. So, clotting factors analysis is suggestible because in most of the cases, sudden bleeding disorders appear due to the defects in clotting factors. However, the general tests such as total blood count, prothrombin time, aPTT (activated partial prothrombin time) PFA-100 (platelet function assay) are also helpful to evaluate the patients profile in a systematic way because sometimes, the symptoms may not appear every time and they will be revealed in general medical tests.