Question

16 years old male patient who has had bleeding gums & skin rash over last few days, he asked medical advice & here are his laboratory results: HB: 12 g/dl WBCs: 6000 PLT: 40000 Bleeding time: 12 min INR:1.1 PTT: 35 second Which of the following is the most probable diagnosis: Select one: a. Idiopathic Thrombocytopenic Purpra (ITP) b. None of the above c. Hemophilia A d. Von Willebrand disease

Answer 1

Presenting features :-

• Bleeding gums.
• Skin rashes.

Laboratory results :-

• HB - 12 g/dl
• WBCs - 6000
• Platelets - 40000
• Bleeding time - 12 minutes
• INR - 1.1
• PTT - 35 sec

Probable diagnosis - Idiopathic Thrombocytopenic Purpura

?There is decrease in platelets count. Normal count is 150000-450000

?The bleeding time has increased. Normal is 2-7 minutes but here 12 min.

?There is normal INR (International Normalised Ratio) which is a measure of how long blood takes to clot. It evaluates the clotting factors of extrinsic and common pathway (Factors - I, II, V, VI, X).

?WBCs are normal and slight decrease to normal hemoglobin levels.

?PTT (Partial Throboplastin Time) is also normal. It evaluate the clotting factors of intrinsic and the common pathways (Factors - I, II, V, VIII, IX, X, XI, XII). So there is no deficiency of clotting factors of intrinsic and common pathways of the cascade.

So from above it can be most probably diagnosed as Idiopathic thrombocytopenic purpura.

Other options are incorrect since :-

?In Hemophilia A there is a deficiency in factor VIII or the activity of factor VIII is decreased which can be manifested by typically prolonged PTT. But here PTT is normal and the count of platelets are also decreased. So it is excluded.

?In case of Von willebrand disease, there is normal platelet count and decreased activity of Factor VIII due to deficiency of von willebrand factor (vWF). But here platelet count is severely deceased and PTT is also normal. So it is also excluded.

So the correct answer is (a) ITP.