April 2019 — Hematology

A 70-year-old female presented with refractory gross hematuria one day after uncomplicated cystoscopy and fulguration of a benign bladder mass. She was treated with continuous bladder irrigation, evacuation of blood clot, and transfused red blood cells.

Her only history of bleeding was menorrhagia in the setting of uterine fibroids. She denied epistaxis, melena, hematochezia, or prior history of hematuria. She also denied bleeding with prior surgical procedures.

Prior to surgery, labs demonstrated normal hemoglobin and platelet count.

Laboratory evaluation during hospital stay
Hemoglobin (Ref range: 12-15.0 G/dL 6.9
Platelets (Ref range: 150-450x109/L 195
APTT  (Ref range: 25-37 sec) 46
PT (Ref range:  9.4-12.5 sec) 11.2
VWF activity screen: Latex Immunoassay  (Ref range: 55-200%) 7
VWF activity: Ristocetin Cofactor (RCo) (Ref range: 55-200%) <12
VWF antigen (Ref range: 55-200%) 12
FVIII activity (Ref range: 55-200%) 10
VWF activity/antigen (≥0.7) 0.58
VWF multimers Plasma VWF multimers are abnormally distributed with decreased higher molecular weight multimers  (below)

Monoclonal Protein Study Positive for a monoclonal IgG lambda paraprotein
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Image of Meera Sridharan, M.D., Ph.D.
Resident, Special Coagulation
Mayo Clinic
Assistant Professor of Medicine and Oncology
Mayo Clinic College of Medicine
Image of William L. Nichols, Jr. M.D. William Nichols, Jr., M.D.
Consultant, Hematology
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology and Medicine
Mayo Clinic College of Medicine

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