shirish_sss
Forum Senior
Topics: 32
Posts: 134
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A 35 YEARS OLD BLACK WOMAN WITH A HISTORY OF PSYCHOTIC DISORDERS GAVE BIRTH TO A HEALTHY MALE BABY. THREE HOURS AFTER THE DELIVERY SHE IS STILL BLEEDING AND IS ALREADY TRASFUSED 8 UNITS OF PACKED RED BLOOD CELLS. LAB. STUDIES REVEALED----
PROTHROMBIN TIME (PT) - NORMAL
PARTIAL THROM. TIME(PTT)- PROLONGED
PLATELET COUNT - NORMAL
BLEEDING TIME - NORMAL
FIBRINOGEN DEGRAD. PRODUCTS- NEGATIVE
HER FACTOR VIII CONC. IS ONLY 10%.
ONE ml OF HER PLASMA MIXED WITH 1 ml OF NORMAL PLASMA DOES NOT CORRECT THE PTT.
WHAT IS THE MOST LIKELY CAUSE OF HER BLEEDING.
1) VON-WILLEBRANDS DISEASE
2) BERNARD-SOULIER DISEASE
3) DIC
4) NSAID GIVEN BEFORE DELIVERY
5) A FACTOR VIII INHIBITOR
6) CLASSIC HEMOPHILIA A
7) ANTI-PHOSPHOLIPID SYNDROME
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| smitha
Forum Elite
Topics: 53
Posts: 236
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With a normal, PT, prolonged PTT, and decreased factor VIII, + failure of the mixing study to correct the abnormality, i wud go for ........
ANS: 5........factorVIII inhibitor!!!!!! But if factor VIII normal, iwud DEFINITELY go for antiphospholipid ab. syndrome.....
Here in this case., the pt. developed an inhibitor or anibodies to factor VIII.......
In an antiphospholipid ab. syn, pt. wud be having even false positive VDRL due to the presence of anti cardiolipin abs.........and a Russel viper venom test wud be positive for lupus anticoagulant!!!!!!!
The normal BT rules out the 1, 2 & 4 choices, the normal FDPs r/o the 3rd choice/DIC,and no mention abt. the factor IX, and also the sex of the pt. & presentation, r/o the 6th choice.......
Hope iam correct....................  
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| shirish_sss
Forum Senior
Topics: 32
Posts: 134
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ABSOLUTELY CORRECT SMITHA
YOU HAVE TO ANSWER THIS QUESTION BY WHAT IS CALLED "EXCLUSION METHOD"
i.e. YOU RULE OUT THE WRONG ANSWERS AND YOU R LEFT WITH ONLY ONE CHOICE
AND THAT OUGHT TO BE AN ANSWER
ANY WAY FACTOR VIII INHIBITOR IS COMMON IN MANY WOMEN GIVING BIRTH TO NEW BORN, OR WHO HAVE BEEN PREVIOUSLY TREATED WITH CHLORPROMAZINE THERAPY OR ANY HEMOPHILIAC WHO HAS BEEN TAKING FACTOR VIII INJECTIONS FOR A LONG TIME.
THAT'S THE CORRECT ANSWER.
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