Mixed platelet and coagulation disorders: Pathology review

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Mixed platelet and coagulation disorders: Pathology review


Coagulation disorders


Vitamin K deficiency

Leukemoid reaction

Leukemoid reaction


Mixed platelet and coagulation disorders: Pathology review

USMLE® Step 1 questions

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A 4-year-old girl presents to the emergency department with abdominal pain, diarrhea, and fatigue. The patient was in her usual state of health until yesterday afternoon, when her family returned home from a barbeque. The patient is otherwise healthy and takes no medications aside from amoxicillin for a recent episode of otitis media. According to her parents, the patient’s urine has looked “darker” than usual. Temperature is 39.0°C (102.2°F), pulse is 115/min, respirations are 22/min, and blood pressure is 100/70 mmHg. Physical examination demonstrates a pale appearing girl with diffuse abdominal tenderness to palpation, delayed capillary refill, and gingival bleeding. Multiple tiny, brownish-purple, blanchable spots are noted under the skin. Which of the following laboratory findings are most consistent with this patient’s disease process?  


At the emergency department, a 70 year old male named Max is admitted because of high fever with chills, and hypotension. He complains of having urinary urgency, frequency and dysuria, or painful urination, for the last few days. A few hours after admission, he rapidly deteriorates and starts to bleed from venipuncture sites. Urine and blood cultures are ordered and are both positive for gram negative rods. Lab tests show low platelet count, and bleeding time, PT and PTT are prolonged, fibrinogen is decreased and d-dimers are elevated. Peripheral blood smear shows schistocytes. Now, there’s also an 18 year old female, named Sylvia, that came in with recurrent severe nose bleeds. She also complains of heavy menstrual periods. Family history reveals her father also suffered from bleeding diathesis. Lab tests show normal platelet count, prolonged bleeding time and PTT, and normal PT.

Both Max and Sylvia are suffering from a hemostasis disorder. Hemostasis disorders, also known as bleeding disorders, can be broadly divided into three groups. The first includes problems with primary hemostasis, which is the formation of the weak platelet plug, and so, they’re referred to as platelet disorders. Now, the second group includes problems with secondary hemostasis, which is making a strong fibrin clot through activation of the intrinsic, extrinsic and common coagulation pathways, and are also known as coagulation disorders. And the last group includes disorders that affect both primary and secondary hemostasis and are known as mixed platelet and coagulation disorders. Okay, in this video, we will focus on mixed platelet and coagulation disorders, that include disseminated intravascular coagulation, or DIC, and von Willebrand disease.


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  3. "Diagnosis and Treatment of Benign Bleeding Disorders" Journal of the Advanced Practitioner in Oncology (2016)
  4. "Bleeding and Coagulopathies in Critical Care" New England Journal of Medicine (2014)
  5. "Disseminated intravascular coagulation" Nature Reviews Disease Primers (2016)
  6. "von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA)" Haemophilia (2008)
  7. "The diagnosis and management of von Willebrand disease: a United Kingdom Haemophilia Centre Doctors Organization guideline approved by the British Committee for Standards in Haematology" British Journal of Haematology (2014)

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