A 25-year-old asymptomatic female underwent a preoperative coagulation test. Her BT is 3, PT is 15/14, aPTT is 45/35, platelet count 2.5 Iac/mm3 and factor VIII levels were 60 IU/dL. She most likely has:
Correct Answer: Factor VIII inhibitors
Description: Ans. c. Factor VIII inhibitors (Ref: Wintrobe's 12/e p1447-1453; Harrison 19/e p734-735, 740, 18/e p982)This is a case of 25-year old asymptomatic female, BT is 3 (normal), PT is 15/14 (normal), aPTT is 45/35 (raised), Platelet count is 2.5 lac mm3 (normal) and Factor VIII levels were 60 IU/dL (normal i.e. between 50-150%). She most likely to has factors VIII inhibitors.Factor IX deficiency* Both PT and PTT are increasedVon-Willebrand's disease-Type III* Prolonged Bleeding time* Normal platelet count and PT* Prolonged PTTFactor VIII Inhibitors* Acquired coagulant inhibitor is immune-mediated condition characterized by autoantibody against a specific clotting factor and factor VIII is most common target.* In 50% of patients no underlying disease is identified at the time of diagnosis.* In remaining the causes are autoimmune diseases, malignancies, dermatologic diseases, pregnancy and post partum.* Diagnosed by isolated prolongation of PTT with normal PT (coagulation profile is similar to hemophilia A)* Normal platelet count and bleeding timeLupus Anticoagulant* Mild thrombocytopenia* Prolonged PTT* Hypoprothrombopenia due to antibodies against prothrombin.
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