Case 5 A 30-year-old man is admitted to the hospital with neurologic impairment,

Question

Case 5

A 30-year-old man is admitted to the hospital with neurologic impairment, fever, edema, bruising, and bleeding gums.

Manual differential counts:

WBC: 12.3                                      Band neutrophils: 5

RBC: 2.60                                       Segmented neutrophils: 64

Hgb: 8.0                                          Lymphocytes: 30

Hct: 23.8                                         Monocytes:

MCV: 91.5                                     Eosinophils:

MCH: 30.7                                     Basophils:

MCHC: 33.6                                   Metamyelocytes: 1

RDW: 19.9                                     NRBCs: 6/100 WBCs

PLT: 9.0                                          Moderate polychromasia

PT: 12.5 sec

aPTT: 33.1 sec

Plasma is hemolysed even with a nontraumatic venipuncture.

Describe the peripheral blood findings.

2. Interpret the coagulation screening tests.

3. What additional tests should be performed?

The results of the proposed additional studies were as follows:

Chemistry tests: consistent with renal disease (increased BUN and creatinine)

Indirect bilirubin: increased

LD: increased

Plasma-free hemoglobin: increased

Haptoglobin: not detectable

d-dimer: 0.1 g/mL

4. Based on all the data provided, what condition is most likely?

5. What information is most diagnostic?

Explanation / Answer

Situation likely seems to be haemophilia or yellow fever and coagulation screening test also indicates haemostatic problem in the patient that is suffering from bleeding gums along with edema and fever. Most likely go for haemophilia confirmation via factor VII and ix.

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