Match each clinical presentation and coagulation laboratory profile to the most likely underlying hematologic diagnosis.
- A 42-year-old hospitalized man with gram-negative bacteremia develops spontaneous oozing from his intravenous catheter sites. Laboratory studies reveal prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), significantly decreased fibrinogen, and thrombocytopenia.Disseminated intravascular coagulation (DIC)
- A 16-year-old girl is evaluated for heavy menstrual bleeding since menarche and recurrent epistaxis. Laboratory studies reveal a normal PT, mildly prolonged aPTT, normal platelet count, and prolonged bleeding time.von Willebrand disease
- A 9-year-old boy presents with severe right knee pain, warmth, and swelling following a minor trip and fall. Laboratory studies reveal a normal PT, markedly prolonged aPTT, normal platelet count, and normal bleeding time.Hemophilia A
- A 28-year-old woman presents with newly developed scattered petechiae over her lower extremities following a recent upper respiratory tract infection. Laboratory studies reveal a normal PT, normal aPTT, normal fibrinogen, and a platelet count of 12,000/mm³.Immune thrombocytopenia (ITP)
Cevap
The presentations match with DIC, von Willebrand disease, Hemophilia A, and ITP respectively, based on whether the defect involves primary hemostasis, secondary hemostasis, or broad factor consumption.
Correct matching requires distinguishing between primary hemostasis disorders (involving platelets and von Willebrand factor, presenting with mucocutaneous bleeding and prolonged bleeding time) and secondary hemostasis disorders (involving coagulation factors, presenting with deep tissue bleeding and prolonged PT/aPTT).
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Anahtar Kavram
Diagnosis of bleeding disorders using clinical presentation and coagulation profiles