Match each patient's clinical presentation with the underlying pathophysiology that best explains their bleeding disorder.
- A 28-year-old woman at 37 weeks gestation develops placental abruption and subsequently oozes blood from her intravenous catheter sites.Systemic activation of coagulation leading to widespread consumption of clotting factors and platelets, with secondary fibrinolysis.
- A 35-year-old otherwise healthy woman presents with isolated mucosal bleeding and scattered petechiae on her legs.IgG autoantibody-mediated clearance of platelets by tissue macrophages, primarily in the spleen.
- A 17-year-old girl reports heavy menstrual bleeding and frequent nosebleeds; her mother has a similar history.Deficiency of a multimeric glycoprotein that impairs both platelet adhesion to subendothelium and carrier function for Factor VIII.
- A 5-year-old boy presents with acute hemarthrosis in his left ankle after a minor jump; his maternal uncle has a history of bleeding issues.X-linked recessive inherited deficiency of a coagulation factor essential for the intrinsic tenase complex.
- A 45-year-old man with end-stage renal disease on hemodialysis presents with prolonged bleeding from his arteriovenous fistula puncture sites.Impaired platelet adhesion and aggregation due to accumulation of guanidinosuccinic acid and other toxins, despite a normal platelet count.
Answer
Match the clinical vignettes to their corresponding pathophysiological mechanisms: Placental abruption to consumptive coagulopathy (DIC); Isolated petechiae in a healthy woman to IgG autoantibodies (ITP); Heavy menses and epistaxis to multimeric glycoprotein deficiency (vWD); Hemarthrosis with X-linked history to intrinsic tenase complex factor deficiency (Hemophilia); ESRD bleeding to uremic toxin-induced platelet dysfunction.
Each patient presentation contains classic hallmark signs for a specific bleeding disorder. Placental abruption is a classic trigger for DIC (consumptive coagulopathy). Isolated mucocutaneous bleeding in a young woman points to ITP (autoantibody-mediated). Mucosal bleeding with an autosomal dominant inheritance pattern indicates vWD (vWF deficiency). Hemarthrosis with an X-linked inheritance pattern strongly suggests Hemophilia (Factor VIII/IX deficiency). Finally, bleeding in a dialysis patient is typical for uremic platelet dysfunction (toxin-mediated).
Step-by-Step Solution
Key Concept
Pathophysiology and clinical presentation of bleeding disorders