Quick Question: 41 YO Man With GI Bleeding

February 1, 2019 Quick Question Case A 41-year-old man was admitted with severe gastrointestinal bleeding. He reported that he drinks an average of 15 ounces of whiskey per day, a habit of 15 years. Upon admission he was given Librium for withdrawal and parenteral nutrition with multivitamins. He was jaundiced and reported the jaundice had […]

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Bleeding Disorders

Jan 30 2019

george

Quick Question: 6 YO Boy with Chronic Bleeding

Please click or tap our December 31, 2018 Quick Question post, a case study of a 6-year-old boy with chronic bleeding. We had a 2018–19 record 76 responses. The choices and responses are as follows. Answers Platelet function abnormality: 10 (13%) Von Willebrand disease: 14 (18%) Factor VII deficiency: 4 (5%) Factor XII deficiency: 4 […]

Bleeding Disorders

Assaying Factor Concentrates

A pre-publication article, Young G, Perry D, The International Prophylaxis Study Group (IPSG). Laboratory assay measurement of modified clotting factor concentrates: a review of the literature and recommendations for practice. J Thromb Haemostas pre-publication, 1-22-19 provides advice on how to measure extended half-life and B-domain-deleted factor concentrates VIII and IX. The article illustrates the wide […]

Bleeding Disorders

Nijmegen-Bethesda Assay

Beginning with a 2016 Quick Question and continuing to our most recent post in March, 2018, we’ve devoted altogether six entries to the 2012 CDC refinements of the Nijmegen-Bethesda assay. These have culminated in the following material, which appears in Fritsma GA, Chapter 41, Laboratory Evaluation of Hemostasis; in Keohane EM, Otto C, Walenga JM. […]

Bleeding Disorders

Platelet Signaling Disorder

A patient experiences chronic moderate bleeding from a surgical site and venipuncture sites over 48 months. The bleeds consistently require intervention. There is no epistaxis and minor bruising. The only diagnostic laboratory result is impaired aggregation epinephrine and ADP agonists, and absence of arachidonic acid-induced aggregation. All other hemostasis and hematology results report within their […]

Bleeding Disorders

Case: 6-year-old Boy with Chronic Bleeding

(Thanks to Dave McGlasson for this case study) A six-year-old boy presented with a history of joint bleeds, hematomas, and occasional deep muscular bleeds. His parents reported that he had experienced no umbilical bleeding but bled from circumcision at two days of age, reaching a hemoglobin level of 3.1 g/dL, requiring transfusions and surgery. There […]

Bleeding Disorders

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, […]

Bleeding Disorders

ASH Choosing Wisely Champions

The American Society of Hematology named two Choosing Wisely champions at the 2018 ASH Convention in San Diego. The champions are Prakash Vishnu, MD, of the Mayo Clinic, Jacksonville, who described his work on reducing inappropriate blood. transfusions and Ming Lim, MD, from the Medical University of South Carolina, who described the work that led […]

Bleeding Disorders

Hemophilia B and Extended Half-life Concentrates

Here is another note from Paul Riley, PhD examining the effects of extended half-life factor IX concentrates. on hemophilia B testing. Hemophilia B1: Therapy Classes and Monitoring Factor IX Inhibitor? Y/N Y/N Prophylaxis Conventional half-life recombinant or plasma-derived FIX Extended half-life FIX Preferred assay to measure FIX activity OSA2 (or CSA) CSA (or OSA) 1. […]

Bleeding Disorders

More on HemLibra

I follow-up to our October 6, 2018 post describing emicizumab (HemLibra), I have correspondence dated 9/10/18 from Paul Riley, PhD, MBA, Stago Scientific Business Development Manager for North America. Paul writes, “I was wondering if you should put something on FF about emicizumab, like a survey to find out how people are dealing with it […]

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Bleeding Disorders

Bleeding Disorders

Quick Question: 41 YO Man With GI Bleeding

Quick Question: 6 YO Boy with Chronic Bleeding

Assaying Factor Concentrates

Nijmegen-Bethesda Assay

Platelet Signaling Disorder

Case: 6-year-old Boy with Chronic Bleeding

Case: 37 year-old Female with Lifelong Epistaxis

ASH Choosing Wisely Champions

Hemophilia B and Extended Half-life Concentrates

More on HemLibra

George Fritsma MS MLS

Cheat Sheets from George

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