What have we found out so far?
We have a 67 year old gentleman who has presented with a 2 day history of thigh pain and swelling. An u/s has shown an intramuscular haematoma.
He was on warfarin for AF but this has been reversed with vitamin k.
The nurse has also noted that he is bruising around the site of the blood pressure cuff and it also takes around 5 mins of pressure to stop bleeding following venepuncture.
The patient has had previous hernia surgery with no bleeding problems. He denies any other history of bleeding and there is no family history of bleeding
Bloods
Hb 85
Mcv 78
Plt 500
Wcc 13
INR on admission 2.3
Coag post vit k
Pt 13
Aptt 85
Aptt actin fs 87
Fib 4.3
No lupus anticoagulant is found
Factor VIII 1%
Factor IX 99%
Factor XI 103%
Factor XII 95%
What do these results suggest? Do we need to do further investigations?
How and where would you manage this patient? Is there anything else from the history which we need to find out?
