Case Study

A 15-year-old boy with chronic strep throat has presented with excessive bruising. His coagulation results were as follows:

PT 15.5 seconds (Reference range, 10.8 to 13.5)

aPTT 42.1 seconds (Reference range, 28.5 to 35.5)

Platelets 325,000 (Reference range, 150,000 to 400,000)

Bleeding 5 minutes (Reference, 8 minutes)

Which coagulation tests are abnormal, and how should this physician proceed in his treatment of this patient? Insights to the Case Study

In this case, two parameters, the PT and aPTT, are elevated. The patient is not bleeding, but he shows a history of recent bruising. Since both the PT and the aPTT are affected, one can assume the problem is in the common pathway, specifically factors I, II, V, and X. Factor assays could be performed to assess the level of activity of each of these clotting factors; however, a closer examination into the patient's history might reveal an additional feature. Since this patient has had chronic strep throat, it is logical to assume that he has been on long-term antibiotics. Antibiotics may deplete the normal flora, a source of vitamin K synthesis. Factors II, VII, IX, and X are vitamin K-dependent factors. Vitamin K is the essential cofactor for the gamma carboxyglutamic acid residues necessary to activate these factors. When vitamin K is in short supply or depleted, these factors fail to function properly. In our patient, vitamin K can be given by mouth to resume normal coagulation and correct bruising.

Was this article helpful?

0 0
The Prevention and Treatment of Headaches

The Prevention and Treatment of Headaches

Are Constant Headaches Making Your Life Stressful? Discover Proven Methods For Eliminating Even The Most Powerful Of Headaches, It’s Easier Than You Think… Stop Chronic Migraine Pain and Tension Headaches From Destroying Your Life… Proven steps anyone can take to overcome even the worst chronic head pain…

Get My Free Audio Book

Post a comment