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Clinical Case 3
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Objectives:

  • Obtain a thorough bleeding history
  • Use laboratory testing to assist in the diagnosis of a bleeding disorder
  • Identify common congenital bleeding disorders
  • Identify and treat common acquired bleeding disorders
  • Identify the role of drugs in producing abnormal hemostasis



1

The patient's 22-year-old sister presents to your office for a routine obstetric visit. "We do everything together-even pregnancy!" She is G1 P0 and is at 20 weeks gestation. She has noticed some spontaneous bruising and gingival bleeding while flossing. She feels well otherwise and has no significant past medical history. She is taking only prenatal vitamins. Her CBC is as follows: WBC 6,000/mm3, hemoglobin 11.2 g/dL, platelet count 20,000/mm3, and no protein on urine dipstick. She says, "Look! I've even got the same problem as my sister. Oh, well." You counsel her and initiate therapy including all of the following EXCEPT:
A)Start prednisone 1 mg/kg daily.
B)Tell her that her infant will have a 10% chance of a transient platelet count less than 50,000/mm3 at birth.
C)Tell her that she may need a splenectomy at some point during her pregnancy.
D)Recommend that the baby be delivered by cesarean section.
E)Explain that her infant's platelet count will likely reach its lowest point several days after birth.







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