The patient is rather unwell with a community acquired pneumonia and requiring supplemental oxygen and intravenous antibiotics. She is not ‘septic’ with low BP etc. There is no history of bleeding and the coagulation screen 5 years pre knee operation was normal. Further testing has been done:

• PT 14s (11-14s)
• APTT 48s (33-40s)
• APTT 50:50 mix 47s
• Fibrinogen (Clauss) 4.9g/L (1.5-4.5g/L)
• Thrombin time 16s (15-19s)

Questions

• What explains the above findings?
• What further testing do you need?
• How do you follow this up?
• Can she have prophylactic LMWH?

Please reply to us (@teamhaem) on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion and learning.