MCQ Hematology Answer 17

Answer: E

Patients with CLL may have aberrant immune responses that include the development of antibodies to coagulation factors. In this case, the patient had a low factor VIII ( and, on further testing, low VWF) due to an acquired antibody to VWF leading to clearance and decreased levels of VWF and factor VIII. A lupus anticoagulant or a decreased factor XII would not be expected to lead to bleeding, which the patient reports. Although decreased factor IX or factor XI levels could lead to bleeding, there is no past history or family history of bleeding, and acquired antibodies to these factors are exceedingly rare.

References:

1. Tefferi A, Nichols WL. Acquired von Willebrand disease: concise review of occurrence, diagnosis, pathogenesis, and treatment. Am J Med 1997;103:536-40.

2. Veyradier A, Jenkins CSP, Fressinaud E, Meyer D. Acquired von Willebrand syndrome: from pathophysiology to management. Thromb Haemost 2000; 84:175-82.

Category: Hematology MCQs