April 2018 — Clinical Pathology

A 71-year-old female presented with recent onset severe epistaxis and generalized ecchymoses, without antecedent trauma over the prior 2 to 3 weeks. For the severe epistaxis, she required nasal packing and received a platelet transfusion. She had no prior history of bruising or bleeding. Laboratory results: Hb 12.3 g/dL, Platelet count 245 x 109 /L, PT 9.2s (RR: 8.4-12s), INR 0.9, APTT 27s (RR:21-33s), Thrombin time 19s (RR: 16-25s), PFA Collagen-Epi >265s (RR 70-165s), PFA Collagen-ADP 152s (RR 50-115s), Factor VIII activity 174% (RR 55-205%), VWF Antigen 170% (RR 55-200%), Ristocetin Cofactor 192% (RR 55-200%), and normal Factor XIII qualitative assay. Her platelet aggregation studies were as follows:

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  Jose Jara Aguirre, M.D.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
  Aneel Ashrani, M.D.
Consultant, Hematology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
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