Clinicopath      

Case records of the JANAAN HEALTH      

Janaan heath case report of the week 3 November 2016 A 86 years old lady was brought in to the emergency department by ambulance having complaining of the right leg swelling and lower abdominal bruising for 3 days. She was conscious with GCS 15/15, Blood pressure 100/80 mmhg, pulse 100 sinus, ECG NAD, saturations 100% ambient air Haemodynamically stable in ED Examination by ED registrar revealed Swelling of the right leg up to the mid thigh, very painful to touch with limited movements due to pain She also had left flank bruising. Rest of the system examinations were unremarkable. An initial diagnosis of right leg DVT were She was given a stat dose of LMWH Dalteparin 17000unit sc and an urgent US Doppler was requested, She had blood tests HB 120 WCC 5.6 PLT 340, neutrophils4.5 lymphocytes2.8, LFTs normal, Creatinine 120, urea 12.0, calcium 2.36 APTT 120, PT 12, Fibrinogen 5.9, Thrombin time 20, D-dimmer :normal. Laboratory contacted the responsible medical team on call and Her case was then discussed with haematologist registrar in her first year of training Following the discussion with attending consultant haematologist the patient was seen immediately by haematology team A clinical diagnosis of acquired haemophilia was made. Patient was resuscitated with fluid resuscitations, adequate analgesia Secondary investigations warranted immediately, includes APTT 50/50 mixing study Factor 8 assay Inhibitor assay Patient was given bypassing agent FEIBA (activated PCC) 50unit/kg stat and BD Further detailed history and CT chest neck abdomen and pelvis revealed no significant abnormalities […]