October 2016 - Presented by Dr. Saba Ali & Dr. Denis Dwyre

Clinical History

An 18-year old female with a history of asthma presented to the clinic with the primary complaint of bilateral knee pain (4-5/10) that is mostly associated with running.  She reports easy bruising and superficial hematomas in the past which resolve with difficulty.  She has no history of major trauma except for a broken finger which resulted in major bleeding but no other problems. The bleeding was not treated. She denies menorrhagia. A family history of a tendency to bleed easy is noted.

Physical examination is unremarkable (blood pressure: 110/60, pulse: 63, O2 saturation: 98%, afebrile) No current skin bruising or joint swelling is noted. Abdomen is soft and nontender.

Laboratory results:

WBC: 7.4 k/mm3 aPTT: 26.8 seconds (reference range: 24.1 - 36.7 seconds)
Hemoglobin: 13.1 gm/dL Factor VIII assay: 114% (reference range: 50 - 150 % NHP)
Hematocrit: 38.0% INR: 0.95
MCV: 86.4 um3 vWF antigen: 107 (reference range: 50 - 150 % NHP)
Platelet count: 159 k/mm3 Ristocetin cofactor: 59 (reference range: 50 - 150 % NHP)
MPV: 11.4 um3

Platelet Aggregation:

THROMBIN 0.92 0.5 - 21 MMOLE
COLLAGEN, impedance 26 17.3 - 51.3 OHMS
COLLAGEN, luminescence 0.85 0.3 - 1.7 MMOLE
RISTOCETIN, impedance 0 (L) 5.0 - 30.0 OHMS
ARACHIDONIC ACID, impedence 14 4.7 - 37.6 OHMS
ARACHIDONIC ACID, luminescence 0.62 0.1 - 1.7 MOLE

Peripheral blood smear: No significant abnormality.  The platelets are normal in number with rare larger forms.

Which one of the following steps would be most useful in distinguishing the disorders that account for these findings?

Choose one answer and submit.





 

The correct answer is

D. Von Willebrand factor (vWF) multimer analysis

> Learn more about this diagnosis.