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Case: 37 year-old Female with Lifelong Epistaxis

(Case provided by Dave McGlasson, please click on Comments to answer)

A 37 year-old female complains of recurrent severe epistaxis (nosebleeds) since childhood, occasionally requiring packing or cauterization. She also reports menorrhagia since menarche (menstruation onset) and easy bruising. She experienced no abnormal bleeding during three successful pregnancies. Her father also experiences epistaxis, easy bruising, and hematomas following venipuncture.

  • Sister and daughter: epistaxis, easy bruising, and menorrhagia
  • Mother and sons: no abnormal bleeding

Patient’s initial laboratory results:

Hemoglobin 10.8 g/dL 12.0–15.0 g/dL
Hematocrit 32% 35–49%
RBC count 3.1 X 106/uL 3.8–5.2 X 106/uL
Prothrombin time 13.2 seconds 12.6–14.6 seconds
Partial thromboplastin time 38 seconds 25–35 seconds
Thrombin time 19 seconds ≤ 21 seconds

What are the most likely diagnoses and what laboratory tests should be performed?

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Bleeding Disorders

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