Residency Program - Case of the Month
October 2016 - Presented by Dr. Saba Ali & Dr. Denis Dwyre
Clinical History
An 18-year old female with a history of asthma presented to the clinic with the primary complaint of bilateral knee pain (4-5/10) that is mostly associated with running. She reports easy bruising and superficial hematomas in the past which resolve with difficulty. She has no history of major trauma except for a broken finger which resulted in major bleeding but no other problems. The bleeding was not treated. She denies menorrhagia. A family history of a tendency to bleed easy is noted.
Physical examination is unremarkable (blood pressure: 110/60, pulse: 63, O2 saturation: 98%, afebrile) No current skin bruising or joint swelling is noted. Abdomen is soft and nontender.
Laboratory results:
| WBC: 7.4 k/mm3 | aPTT: 26.8 seconds (reference range: 24.1 - 36.7 seconds) | |||
| Hemoglobin: 13.1 gm/dL | Factor VIII assay: 114% (reference range: 50 - 150 % NHP) | |||
| Hematocrit: 38.0% | INR: 0.95 | |||
| MCV: 86.4 um3 | vWF antigen: 107 (reference range: 50 - 150 % NHP) | |||
| Platelet count: 159 k/mm3 | Ristocetin cofactor: 59 (reference range: 50 - 150 % NHP) | |||
| MPV: 11.4 um3 | ||||
Platelet Aggregation:
| THROMBIN | 0.92 | 0.5 - 21 MMOLE | ||||
| COLLAGEN, impedance | 26 | 17.3 - 51.3 OHMS | ||||
| COLLAGEN, luminescence | 0.85 | 0.3 - 1.7 MMOLE | ||||
| RISTOCETIN, impedance | 0 (L) | 5.0 - 30.0 OHMS | ||||
| ARACHIDONIC ACID, impedence | 14 | 4.7 - 37.6 OHMS | ||||
| ARACHIDONIC ACID, luminescence | 0.62 | 0.1 - 1.7 MOLE |
Peripheral blood smear: No significant abnormality. The platelets are normal in number with rare larger forms.
Which one of the following steps would be most useful in distinguishing the disorders that account for these findings?
Choose one answer and submit.
D. Von Willebrand factor (vWF) multimer analysis
> Learn more about this diagnosis.
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