Case 76 – update 1

Our three day old child is admitted unwell and has deranged clotting with a markedly prolonged APTT. The team wanted an ultrasound scan which confirms a small intraparenchymal bleed. Repeat coagulation testing shows:

  • PT 18s (12-14 adult)
  • APTT 92s (30-38 adult)
  • APTT 50:50 mix with normal plasma 38s
  • Clauss fibrinogen 2.6g/L (2-4)

Liver function tests are within normal limits. The parents are fit and well with no past medical history. The pregnancy was uneventful save for an element of iron deficiency which resolved with supplementation.

Questions

  • Given the clinical history and the coagulation results what are the differential diagnoses?
  • What does 50:50 mix mean?
  • You’re in a district general hospital – what would be your immediate management?

 

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