toddler with many bruises on legs and arms and PTT is prolonged

[usmlethinking]

The parents of a 13-month-old boy are contacted by a local social agency because the day care they are using has reported them for
suspected child abuse. The abuse was suspected because the day care personnel thought that the toddler had "too many bruises." The
parents deny the abuse, and promptly arrange to have their child seen by the chairman of the pediatrics department in a clinic run by a
university medical center. On physical examination, the child is noted to have multiple large bruises on his legs, arms, and buttocks. No skin
abrasions are seen, and no "pattern marks" (suggestive of being hit by an object such as a belt buckle or rod) are seen. A blood smear isunremarkable. PTT is prolonged, and PT and bleeding times are normaI.

Which of the following is the most likely diagnosis?
A. Acute myelogenous leukemia
B. Disseminated intravascular coagulation
C. Hemophilia
D. Thrombocytopenia
E. Von Willebrand's disease

is it hemophilia

[md123]

Originally Posted by Unregistered

is it hemophilia

I think its VOn Willebrand's diease,because PTT is prolonged in it as well,along with deficiency of a part of factor 8.it causes superficial and deep bleeding.

Whereas Hemophilia doesn't present with bruises,always deep bleeder,like haemarthrosis.

Well, since PTT is prolonged we know its an intrinsic definciency (i.e. factor VIII) and so we can narrow it down to Hemophilia A or vWD. But since they tell you there is no increase in bleeding time, its more likely to be Hemophilia. But this question sucks cause they really dont give you enough info since approximately 50% of vWD patients dont have an increase in Bleeding time either. Plus with no family history of hemophilia and no joint swelling or anything, and considering vWD is so much more common, vWD would be my guess. Do the ristocetin test!!! LOL...

Val

[dradi]

i think its vWD.i agree with val`s explanation.but just wanted to point out one thing.this case mentions the child having a platelet type of bleeding (like in vWD) and not deep seated (eg. hematoma, hemarthroses...as in hemophilia)

[tuffcore]

It is hemophilia. The classic hemophilia case is inc. PTT and Nl PT and Bleeding Time. The child is only 13 months. It is quite possible that there are no hemarthroses yet, or they have gone unnoticed. Hemophilia is also known for easy bruising. VWD would have inc bleeding time before inc. PTT esp. for the boards.

[tuffcore]

Also the child is a boy, making hemophilia a good bet, as it is xlinked.

[pkhatri]

this is hemophilia as the pt is male and others answers cannot explain only elevation of APTT.