Bleeding Disorders — Clinical

A 28-year-old woman presents to the emergency department with a 3-day history of severe mucosal bleeding, including epistaxis, gingival bleeding, and menorrhagia. She reports no prior bleeding history. On examination, she is pale with petechiae and ecchymoses over the lower extremities. Laboratory investigations reveal: Hemoglobin 8.2 g/dL, Platelet count 8,000/μL, PT 12 s (normal), aPTT 32 s (normal), Fibrinogen 280 mg/dL (normal). Peripheral blood smear shows no schistocytes. What is the most likely diagnosis?

A 52-year-old man with a history of metastatic pancreatic cancer presents with acute onset of severe bleeding from the gums and nose. He is on palliative chemotherapy. Laboratory findings: PT 28 s (normal 12–14 s), aPTT 58 s (normal 25–35 s), Platelet count 45,000/μL, Fibrinogen 95 mg/dL (normal 200–400 mg/dL), D-dimer 8.5 μg/mL (markedly elevated). Prothrombin time corrects after mixing study. What is the most likely diagnosis?

Which of the following bleeding disorders is characterized by a normal bleeding time but prolonged prothrombin time (PT)?

A 28-year-old woman from rural Maharashtra presents with a 3-day history of severe epistaxis and gum bleeding. She reports easy bruising for the past 2 weeks and denies any recent trauma or medication use. On examination, she has petechiae on her lower extremities and oral mucosa. Laboratory findings show: Hemoglobin 9.2 g/dL, WBC 6,500/μL, platelets 8,000/μL, PT 12 s (normal), aPTT 32 s (normal), bleeding time 8 min (prolonged). Bone marrow examination shows normocellular marrow with increased megakaryocytes. What is the most likely diagnosis?

A 52-year-old man with a 10-year history of cirrhosis due to hepatitis C presents to the emergency department with hematemesis and melena. On examination, he is tachycardic (HR 110/min), hypotensive (BP 85/50 mmHg), and has clinical signs of portal hypertension (splenomegaly, ascites, spider angiomas). Laboratory investigations show: Hemoglobin 7.8 g/dL, platelets 45,000/μL, INR 2.8, aPTT 48 s, albumin 2.1 g/dL, total bilirubin 4.2 mg/dL. Upper endoscopy confirms bleeding esophageal varices. Which of the following best explains the coagulation abnormality in this patient?