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A 5-year old boy presents with ongoing bleeding 24 hours after a tonsillectomy. The surgeon reports moderate bleeding during the procedure, and the mother reports that the bleeding has been steady during the night hours since the surgery. The patient has no history of past bleeding, but he has not had any significant bleeding challenges before this procedure. The platelet count is normal as are the prothrombin time, aPTT, thrombin time, and fibrinogen levels; the hemoglobin is 9.2 gm/dl, decreased from the pre-operative level of 11.2 gm/dl. A bleeding time is normal, and results of the platelet function analyzer (PFA-100) are normal with both the epinephrine+collagen and ADP+collagen cartridges. What further evaluation should be done?
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Coagulation screening tests of the patient’s mother
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Alpha2 antiplasmin level
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d-Dimer level
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Factor XI level
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Electron microscopic study of the patient’s platelets
Answer
Category: Hematology MCQs
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