(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|
|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?