Approach to bleeding disorders (coagulopathy) Quiz: Ace Your Exams
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A 40-year-old woman presents to her primary care physician with concerns about recent easy bruising. She notes that the bruises appear spontaneously, without significant trauma, and are particularly pronounced on the lower extremities. She has a history of rheumatoid arthritis currently managed with methotrexate and low-dose prednisone. She has not had any recent infections, arthritis flares or changes in her medication. Vital signs are within normal limits. On physical examination, there is no joint swelling or active synovitis. Multiple non-tender ecchymoses are present on the extremities. Laboratory results are shown below. A mixing study shows that the prolonged aPTT does not correct when the patient’s plasma is mixed with normal plasma. Which of the following is the most likely diagnosis?
| Laboratory value | Result | Reference range |
| Serum chemistries | ||
| Hemoglobin | 11.8 g/dL | 12-16 g/dL |
| Leukocyte count | 5,900 /mm3 | 4,500-11,000 /mm3 |
| Platelet count | 200,000/mm3 | 150,000-400,000/mm3 |
| Prothrombin time (PT) | 12 seconds | 11-15 seconds |
| Activated partial thromboplastin time (aPTT) | 60 seconds | 25-40 seconds |
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