BMLS 402-18 Case Study

 

 

 1. 

PATIENT HISTORY:

A 2-year old boy was brought to the emergency department by his mother for oozing blood from his mouth following a fall nearly 6 hours ago. His mother related that he tended to bleed for prolonged periods from his immunization sites, but there was no history of bruising or hematomas. The patient was on antibiotics for a recent ear infection. There was no known family history of a bleeding disorder.

 PHYSICAL EXAMINATION:

GENERAL: Alert, in no apparent distress, development appropriate for age

HEENT: Two small lacerations on the inside of lower lip, oozing blood

Remainder of exam within normal limits (notably, no petechia, bruises, joint swelling)

INITIAL LABORATORY TESTS:

Hemoglobin	12.3 g/dl	(10.5-13.5)
Hematocrit	35.4%	(33.0-39.0)
WBC	7.9 x 10^9/L	(6.0-17.5)
Platelets	368 x 10^9/L	(156-369)
PT	11.3 s	(10.0-12.8)
APTT	37.2 s	(24.4-33.2)

 As a medical lab scientist which other differential diagnosis you will refer to patient; the primary one describe in detail with all the steps.

 

 

 2.

Steven had just turned 6 months old. He had recently discovered the freedom of being mobile and was attempting to follow his 3 year old sister Heather up the stairs. He had almost mastered crawling up the first step when he slipped and fell, hitting his mouth on the linoleum floor of the kitchen. The screaming brought his mother running who initially thought the baby must have split his head open because of the amount of blood that was everywhere. As she cleaned the injury, she realized that the blood was coming from the baby's mouth. After applying cold compresses for 15 minutes, the bleeding eventually stopped. Five minutes later, the bleeding started up again. She decided to call the pediatrician.

The baby had stopped bleeding by the time the mother arrived at the pediatrician's office. During a thorough checkup of the baby, the pediatrician noticed bruises on the legs and arms. He noted that the baby had not been circumcised. Upon examination of the injured gum area, bleeding started again.

The pediatrician asked the mother if there was any history of bleeding disorders on the maternal side of her family. The mother was not sure, although she thought she may have had a great uncle who died when he was young of a blood disorder.

a. What 3 processes are involved to stop bleeding?

 b. Factor VIII or Factor IX are deficient in Hemophilia.  Which pathway do these factors affect (use the coagulation chart in the workbook to locate these factors). 

 

 3.

A 45 year old man presents in the Emergency Room with a two day history of black covered stools and recurrent nosebleeds. His history reveals both a recent as well as past history of ethanol abuse. His coagulations studies reveal:

 Platelet Count:                    60,000/cumm
PT:                                       20 sec
APPT:                                  52 sec
Thrombin Time:                  11 sec
Fibrinogen:                          201 mg%
FDP                                     greater than 40 μg.ml

 

Ques.

a. What is the probable diagnosis?

b. What additional tests should be performed to confirm the diagnosis?

 

 4.

 A 16 year old girl living in Arizona noted a stinging sensation in her right foot while walking through a field. She subsequently developed a painful swelling in her right footand her right lower leg. Later, she noticed the development of ecchymosis over the same area of the right leg. At the time of an Emergency Room visit, her coagulation studies were:

Platelet Count:                               20,000/cumm

PT:                                                 greater than 100 sec

APPT:                                            greater than 3 min

TCT:                                              greater than 3 min

Fibrinogen:                                    40 mg%

 Ques:

a. What is the possible diagnosis?

b. Define one test in detail.

 

 5. 

A 43-year-old man presents with a 2-month history of fatigue, malaise, and dyspnea on exertion. He does not take any medications. CBC from 2 years ago was normal. On physical exam, there is conjunctival pallor. Hb is 5 g/dL, and HCT is 15%. Reticulocyte count is 20/mL, and RI is 0.1%. WBC and platelet counts are normal. There are very few normocytic RBCs on peripheral smear. CXR is normal except for an anterior mediastinal mass. EKG is normal.

Ques:

a. What type of anemia does this patient have?

 

6.

 A 38 year old man had a history of soft tissue bleeding after minor trauma. He required 4 units of blood following a hemorrhoidectomy.

Bleeding time:               4 min
Platelet Count:              300,000/cumm
PT:                                12 sec
APPT:                           55 sec
TCT:                             10 sec
Fibrinogen:                   275 mg%

Ques:

1. What is the most probable diagnosis?
2. What additional tests should be performed to confirm the diagnosis?

 

 -------------

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

2.

3. 

4.

5.

6.

 

.

.