VII. TEACHING POINTS

1. A history of bleeding after previous surgical procedures or trauma suggests a relatively high likelihood of an underlying coagulation disorder.
2. It is important to obtain a complete family history, which may alert you to an inherited coagulation disorder such as hemophilia A or von Willebrand disease.
3. The laboratory evaluation of a patient with a suspected bleeding disorder should be directed by the findings of the history as well as the physical examination. An evaluation of the PT, the PTT and the complete blood count are typically a common starting point to evaluate the etiology of a patient’s bleeding symptoms.
4. Patients with a diagnosis of hemophilia A will typically have findings and symptoms that are directly related to the level of factor VIII activity. Patients with less than 5% of factor VIII activity are more likely to have spontaneous bleeds into joints (hemarthroses), while less severely affected patients with higher (but still abnormally low) factor VIII levels may have bleeding symptoms only after trauma or surgical procedures.
5. There are other causes of prolonged PTT besides hemophilia A and B. These include hemophilia C (factor XI deficiency) and factor XII deficiency. Factors XII and XI are typically evaluated only if factors VIII and IX are normal.

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