Match each patient's clinical presentation and laboratory coagulation profile to the most likely underlying hemostatic disorder.
- A 24-year-old woman with menorrhagia and epistaxis; laboratory studies show a normal PT, prolonged aPTT, and prolonged bleeding time.von Willebrand disease
- A 6-year-old boy with a swollen, painful knee after a minor fall; laboratory studies show a normal PT, prolonged aPTT, and normal bleeding time. A mixing study with normal plasma fully corrects the aPTT.Hemophilia A
- A 65-year-old man with unprovoked, extensive soft tissue bleeding; laboratory studies show a normal PT, prolonged aPTT, and normal bleeding time. A mixing study with normal plasma fails to correct the aPTT.Acquired factor VIII inhibitor
- A 32-year-old woman with placental abruption who develops continuous oozing from venipuncture sites; laboratory studies show prolonged PT, prolonged aPTT, thrombocytopenia, and low fibrinogen.Disseminated intravascular coagulation (DIC)
Answer
The correct matches correlate von Willebrand disease with combined primary and secondary hemostasis defects, Hemophilia A with a correctable prolonged aPTT, acquired factor VIII inhibitor with an uncorrectable prolonged aPTT, and DIC with consumptive coagulopathy.
Each clinical scenario presents a distinct coagulopathy. von Willebrand disease affects both primary hemostasis and factor VIII stability. Hemophilia represents a true factor deficiency that corrects with normal plasma. Acquired inhibitors neutralize coagulation factors, resisting correction in mixing studies. DIC causes global depletion of coagulation factors, fibrinogen, and platelets.
Step-by-Step Solution
Key Concept
Interpretation of coagulation panels (PT, aPTT, bleeding time) and mixing studies to differentiate hemostatic disorders.