Examkin

Question

Difficulty: MediumHematology and Oncology

Match each patient's clinical presentation with the most likely corresponding coagulation profile.

  • A 19-year-old man presents with right knee swelling and severe pain after a minor fall. He has a lifelong history of recurrent joint swellings and prolonged bleeding following dental procedures. His maternal uncle has a similar bleeding history.PT: Normal, aPTT: Prolonged, Platelets: Normal, Bleeding Time: Normal
  • A 24-year-old woman presents for evaluation of easy bruising and heavy menses. She reports bleeding for an unusually long time after a tooth extraction last year. Her mother also experiences heavy menstrual periods.PT: Normal, aPTT: Normal or Prolonged, Platelets: Normal, Bleeding Time: Prolonged
  • A 42-year-old man with acute promyelocytic leukemia develops sudden onset of epistaxis, hematuria, and continuous oozing from his intravenous catheter sites shortly after initiating induction chemotherapy.PT: Prolonged, aPTT: Prolonged, Platelets: Decreased, Bleeding Time: Prolonged
  • A 28-year-old previously healthy woman presents with sudden onset of diffuse petechiae and easy bruising on her lower extremities. She reports having a mild, self-limiting viral upper respiratory illness three weeks ago. Examination shows no hepatosplenomegaly.PT: Normal, aPTT: Normal, Platelets: Decreased, Bleeding Time: Prolonged

Answer

The correct matches associate Hemophilia with isolated aPTT prolongation, von Willebrand disease with prolonged bleeding time and possibly prolonged aPTT, DIC with derangement of all parameters (prolonged PT/aPTT/bleeding time and decreased platelets), and ITP with isolated thrombocytopenia and prolonged bleeding time.
Each clinical scenario corresponds to a distinct pathophysiological mechanism affecting either primary hemostasis (platelet number or function), secondary hemostasis (coagulation factors), or both. Recognizing the distinctive patterns in PT, aPTT, platelet count, and bleeding time is essential for confirming the underlying bleeding disorder.

Step-by-Step Solution

1
Analyze the clinical history and physical findings for the first patient.
The patient has recurrent hemarthroses and a family history consistent with X-linked inheritance, indicating Hemophilia A or B. This correlates with an isolated intrinsic pathway defect.
Identifying the disease allows for deduction of the expected lab findings (prolonged aPTT with normal PT, platelets, and bleeding time).
2
Evaluate the presentation of the second patient.
Mucosal bleeding, heavy menses, and family history suggest von Willebrand disease, which affects platelet adhesion and potentially Factor VIII stability.
This presentation differentiates a primary hemostasis defect with potential secondary hemostasis involvement (prolonged bleeding time, normal/prolonged aPTT) from pure coagulation factor deficiencies.
3
Assess the third patient's clinical scenario.
Sudden onset of severe bleeding from multiple sites in a patient with APL strongly indicates Disseminated Intravascular Coagulation (DIC).
APL is famously associated with DIC, resulting in a consumptive coagulopathy affecting all parameters (prolonged PT and aPTT, decreased platelets, prolonged bleeding time).
4
Examine the history of the fourth patient.
Post-viral petechiae in an otherwise healthy young woman without splenomegaly points to Immune Thrombocytopenia (ITP).
ITP isolatedly affects platelet count through autoimmune destruction, leaving coagulation factors intact (decreased platelets, prolonged bleeding time, normal PT and aPTT).

Key Concept

Diagnosis of bleeding disorders through interpretation of coagulation panels (PT, aPTT, platelet count, and bleeding time)
Estimated Time:1m 30s
Rate this question

Topics

Hematology and Oncology

More questions from this topic