Here is a case sent in by a colleague. A 75 YO woman with CLL. In April, 2014, she had a prolonged PTT but was not worked up. She recently presented to an outside hospital with weakness and falls and was found to have a HGB of 5.1 g/dL and a PTT of 90 seconds. She was transferred to our institution and found to have a retroperitoneal hematoma by CT. She was transfused with RBCs, FFP, and platelets and is currently hemodynamically stable.
Initial coag studies on admission:
- PT: 12.9 (RI 9.5–12.3 sec)
- PTT: 58 (RI 26–37 sec)
- PTT 50/50 mix: 64 (no incubation)
- DRVVT/LA confirm: 42.6/36.1, negative
- Factor VIII: initially was 3% when using lupus insensitive reagent, was able to obtain 100% with dilution
- All other factors normal or just slightly low, however there was a non-specific inhibitor to IX, XI, and XII
- Bethesda for factor VIII: 182.4 BU; using lupus insensitive reagent, still around 140 BU
Follow-up labs will be posted July 30. What is your diagnosis?