Case 14 – update 3

So the APTT corrects on mixing, therefore dome of you have suggested possible factor deficiency.  Which factors would you request levels for.

The patient is Day 2 of his hospital stay and the nursing staff have witnessed an episode of melaena.  On repeat bloods his HB has fallen to 72g/l.  The medical team contact you as the haematology registrar to review the patient.

You confirm his bleeding history – there is no family history.  He report having dental extractions as a young adult without any problems. He has had no previous surgery.  He has noted some bruising , but he thinks he may just be getting clumsy with age!  He has reported two recent epistaxis but he did not seek medical attention.

The medical team are quite anxious about his ongoing bleeding and ask your advice on investigation and treatment.  What would you suggest?

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1 Response to Case 14 – update 3

  1. Start with factor 11 and 12 assays. Unlikely to be hereditary disorder due to lack of bleeding history and age. Consider acquired haemophilia A

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