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45 hrs after biopsy of a 2-cm mass in the upper outer quadrant of the left breast, a 45yo female has pain and swelling of the left breast. She has no history of bleeding problems and takes no medications. Examination shows an expanding hematoma. A biopsy specimen shows a fibroadenoma. Which of the following is the most likely diagnosis? A) Factor VIII deficiency
B) Factor IX deficiency
C) Inadequate hemostasis
D) Platelet dysfunction
E) Thrombocytopenia
shumaila Forum Elite
Topics: 58 Posts: 347
08/19/06 - 08:58 AM
#2
nocles what is rellationship of bleeding disorder n fibroadenoma?
frank100 Forum Guru
Topics: 48 Posts: 586
08/19/06 - 09:09 AM
#3
inadequate hemostasis is a good bet, but if hematoma keeps on growing, I should think of blood disease.
A and B are X-linked, and she is 45 y/o. so pretty unlikely. thrombocytopenia, could be but, no clue of a posible cause platelet disfunction, can also be a good bet, but nothing in the history sugesting it
frank100 Forum Guru
Topics: 48 Posts: 586
08/19/06 - 09:09 AM
#4
I choose (b)
frank100 Forum Guru
Topics: 48 Posts: 586
08/19/06 - 09:09 AM
#5
frank100 wrote: I choose (b)
sorry i choose (c)
frank100 Forum Guru
Topics: 48 Posts: 586
08/19/06 - 09:10 AM
#6
inadecuate hemostasis
humbty Forum Elite
Topics: 24 Posts: 135
08/19/06 - 10:44 AM
#7
Its delayed bleeding, thats typical for hemophilias.
She is female so severe hemophilia is nearly impossible.
BUT: female carriers have mild hemophilias that often present for the first time after major trauma or surgery.
So with A being the most common hemophilia I would go for A now.
Perhaps Forum Elite
Topics: 61 Posts: 162
08/19/06 - 10:51 AM
#8
Now I think it is A also
will fibroadenoma change the blood vessles somehow?
mazinger Forum Guru
Topics: 46 Posts: 920
08/19/06 - 11:04 AM
#9
Inadequate hemostasis... ___________________ original mazinger z
humbty Forum Elite
Topics: 24 Posts: 135
08/19/06 - 12:01 PM
#10
C,D,E are all primary hemostasis problems (platelet defects) that dont present with delayed bleeding. The present with prolonged initial bleeding.
Hemophilias (disorders of secondary hemostasis/plasma protein defects) present with delayed bleeding.
The presentation is typical for a mild hemophilia. You can read it for example in Harrisons page 681 "Occasional patients with factor VIII levels as high as 25% are discovered when they bleed after major trauma or surgery"
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