A 39 year old woman was readmitted with vaginal bleeding several weeks following

Question

A 39 year old woman was readmitted with vaginal bleeding several weeks following an abdominal hysterectomy. The patient and family bleeding histories were negative, but the patient had been taking aspirin and an antihistamine regularly for many months before the operation. Her coagulations studies showed:

Ivy Bleeding time:                  Greater than 10 min

Friable, soft clot after 24 hours of incubation at 37°C

Remainder of profile:            normal

1. What is the most probable diagnosis?

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

3. What type of therapy should be initiated?

Explanation / Answer

1. Probable diagnosis -

Thrombocytopenia ( characterised by an abnormally low level of platelet in the blood preventing from coagulation)

Fibrinogen deficiency( it is a rare inherited bleeding disorder which is caused by partial /full deficiency, or malfunctioning of fibrinogen in the blood)

2. To detect thrombocytopenia an 'aggregometry' is the test performed. Aggregometry is a test used to check the platelet ability to form a clot.

'Fibrinogen assay' is the test performed to detect the presence of fibrinogen deficiency by determining the level of fibrinogen in the blood, which is also a factor that helps in clotting of blood.

3. if the patient is confirmed with thrombocytopenia, an immediate action must be taken to discontinue the intake of aspirin. Platelet transfusion can be initiated In case of excessive bleeding and low platelet count.

Cryoprecipitate or fibrinogen concentration can be given as the first line of choice if the patient is diagnosed with a fibrinogen deficiency

(Cryoprecipitate is a frozen blood product made out from plasma containing fibrinogen, a natural protein and other components helps in blood coagulation

Fibrinogen concentration is a lyophilised fibrinogen powder made from plasma )

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