So we have an update
Our patient has presented with a long history of epistaxis.
There is no history of easy bruising.
No bleeding after tooth extraction
Her mother died of a brain haemorrhage and also had significant history of epistaxis. The patient also thinks her maternal grandfather had significant history of epistaxis and gi bleeds, and needed several blood transfusions.
On examination, no hepatosplenomegally, no visible oral telangegtasia although there do appear to be several cutaneous telangectasia on the hands.
Fbc shows a microcytic hypochromic anaemia. Ferritin 5.
Claus fib 4.0
Factor VIII 160%
Vw antigen 130%
VW activity 120%
Platelet function test normal
What are the thoughts now?
Are there any other investigations you would like?
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