Making Diagnosis in a Bleeder Case with Impaired Coagulation Study: a Case Reportt

A 14 year old boy with diagnosis of right leg-calve-par thesis had been admitted to orthopedic surgery department in our hospital. He had prothrombin time: 13 second, activated partial thromboplastin time: 33 second and platelet count; 262 x109/μl. The patient had undergone femoral endarterectomy release surgery successfully, but had hemorrhage at site of incision. The bleeding had continued in 3 subsequent days despite daily infusion of 2 bags of fresh frozen plasma. The patient had received 5 bags of packed cell and 16 bags of fresh frozen plasma during subsequent 2 weeks. The results of coagulation study were as follow: factors VIII: 38%, IX: 12.9%, V: 5.6%. In re-interview with the patient, it was revealed that he had history of a severe epistaxis and bleeding after circumcision. The interview with the family directed us to a known case of mild hemophilia B. The treatment changed from plasma to factor IX concentrate with target of reaching to plasma level of 80%. The bleeding at site of incision began to reduce and stopped in second day of infusion of factor IX concentrate and continued till 4 days. After a month the factor IX level was 6%. The second surgery was programmed for 2 months later with infusion of 3000 unit factor IX concentrate before and after surgery that kept on to 5 days later, then tapered to 1500 U until 5 others days. He did not experience any bleeding at site of surgery except epistaxis at 9th and 10th days of hospitalization.