Contributed by Hina A. Sheikh, MD and Franklin Bontempo, MD
Published on line in October, 2002
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.
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:
|WBC||7.9 x 10^9/L||(6.0-17.5)|
|Platelets||368 x 10^9/L||(156-369)|
|APTT MIX||35.7 s||(28.0-38.0)|
|FACTOR VIII||0.16 U/ml||(0.60-1.50)|
|FACTOR IX||0.82 U/ml||(0.60-1.50)|
|THROMBIN TIME||17.3 s||(16.0-22.0)|
|VWF AG||0.16 s||(0.78-1.53)|
WHAT IS THE MOST LIKELY CAUSE OF PROLONGED BLEEDING IN THIS CASE?