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Pediatric and Adult Bleeding Cases

The document presents three clinical cases involving bleeding disorders in patients of different ages and backgrounds. Case 1 describes a 3-year-old boy with excessive bleeding and low Factor VIII levels, likely indicating hemophilia; Case 2 involves a 25-year-old woman with oral bleeding while on low molecular weight heparin, suggesting a bleeding disorder; Case 3 features a 50-year-old man with fatigue and a bleeding gastric ulcer, indicating possible iron deficiency anemia due to chronic blood loss. Each case includes vital signs, physical examination findings, and laboratory results that inform the probable diagnosis, physiological basis, and treatment options.

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21 views3 pages

Pediatric and Adult Bleeding Cases

The document presents three clinical cases involving bleeding disorders in patients of different ages and backgrounds. Case 1 describes a 3-year-old boy with excessive bleeding and low Factor VIII levels, likely indicating hemophilia; Case 2 involves a 25-year-old woman with oral bleeding while on low molecular weight heparin, suggesting a bleeding disorder; Case 3 features a 50-year-old man with fatigue and a bleeding gastric ulcer, indicating possible iron deficiency anemia due to chronic blood loss. Each case includes vital signs, physical examination findings, and laboratory results that inform the probable diagnosis, physiological basis, and treatment options.

Uploaded by

foramsheth2005
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Case 1

A 3-year-old boy is brought to the pediatrician by his parents, who have noted excessive bleeding
around the knees and elbows. The parents have noted that the toddler bleeds very easily when the skin
is scratched. Family history is significant for the presence of Clotting disorder in the mother’s family.

PHYSICAL EXAMINATION

Vital Sign :

T 37.2°C, P 60/min, R 20/min, BP 95/70 mm Hg, 45% for height and 50% weight on the growth charts

Physical Examination:

Erythema is present particularly around the knees and elbows. Purpura is noted on the elbows.

LABORATORY STUDIES:

Complete blood cell count: ● Hemoglobin: 10.9 g/dL (normal: 13.4-17.4 g/dL) ● Hematocrit: 32%
(normal: 40%-54%) ● Platelets: 200,000/mm3 (normal: 150,000- 400,000/mm3) Coagulation Studies ●
Platelets: 412 (normal: 150-440) ● Prothrombin time: 12.5 sec (normal: 11-15 sec) ● APTT (activated
partial thromboplastin time): 42 sec (normal: 26.4-35 sec) ● Bleeding time: 6 min (normal: 2-8 min)
Factor VIII: C level: 5% (normal: 25%-100%) von Willebrand factor antigen: 145% (normal: 71%-210%)

Answer following Question

1. What is probable diagnosis


2. What is physiological basis
3. What is basis of treatment
Case 2

A 25-year-old woman comes to her primary care physician complaining of oral bleeding. The patient has
been on low molecular weight heparin for the past 2 years after the diagnosis of a pulmonary embolism.

Vital Sign: T 37°C, P 70/min, R 18/min, BP 112/70 mm Hg, BMI 28

Physical Examination: Purpura, petechiae, and hemorrhagic bullae in the mouth

Answer following Question

1. What is probable diagnosis


2. What is physiological basis
3. What is basis of treatment
Case 3

A 50-year-old man comes to his family physician complaining of fatigue. The patient indicates that
climbing the stairs leaves him short of breath and that this has been getting progressively worse
over the past month. He does not participate in any regular exercise. The patient works in a stressful
job and to relieve stress the patient smokes, drinks 6 cups of coffee a day, and has two or three
alcoholic drinks after work. He has been taking aspirin for the last 6 months for frequent stomach
pain. The patient has decreased caloric intake for the past 3 months in an effort to lose weight, with
moderate success.

Vital Sign: T 36°C, P 105/min, R 24/min, BP 90/75 mm Hg, BMI 33

Physical Examination: Upper and lower endoscopy reveals a bleeding gastric ulcer.

LABORATORY STUDIES

Hematocrit: 30% Red blood cell smear: Microcytic hypochromic cells Serum iron values: 27 μg/dL
Transferrin saturation: 13% Serum ferritin: 20 μg/L Stool test: Positive for occult blood

Answer following Question

1. What is probable diagnosis


2. What is physiological basis
3. What is basis of treatment

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