Question

An 18 year-old woman presents to the clinic complaining of fatigue. She reports a past history of lifelong frequent nosebleeds and bleeding gums. She also has menorrhagia. Her mother and maternal grandfather have a similar bleeding history. Initial lab results are as follows: WBC 9,500/mm³, Hgb 10.9 g/dL, HCT 33?

1) Hemoglobin electrophoresis
2)Bleeding time and platelet aggregometry
3) Bone marrow aspiration
4) PT and aPTT

Answer 1

The 18-year-old woman's symptoms suggest an inherited bleeding disorder, for which bleeding time, platelet aggregometry, PT, and aPTT are relevant tests. Her mild anemia noted by a low hematocrit may contribute to fatigue but is a separate issue from her bleeding disorder.

Step-by-step explanation:

An 18-year-old woman presents with symptoms consistent with a bleeding disorder, including fatigue, frequent nosebleeds, bleeding gums, and menorrhagia. Considering her personal and family history, she likely has an inherited bleeding disorder. The proposed tests are designed to evaluate different aspects of her blood function. Each test provides crucial information:

• Bleeding time and platelet aggregometry can assess platelet function and bleeding tendency.
• Prothrombin time (PT) and activated partial thromboplastin time (aPTT) test the integrity of the coagulation pathways.
• Hemoglobin electrophoresis is less relevant in this context as it's typically used to identify hemoglobinopathies rather than bleeding disorders.
• Bone marrow aspiration is an invasive test and usually reserved for when a marrow pathology is suspected, like leukemia or other marrow-related diseases.

The hematocrit (HCT) value provided is somewhat low, indicating a potential mild anemia, which could contribute to her fatigue. However, her symptoms and family history suggest an inherited bleeding disorder that is separate from any mild anemia that may be present.