Contributed by Su Zheng, MD, PhD, and Andrea Cortese Hassett, PhD Published on line in April 2001
Contributed by Su Zheng, MD, PhD, and Andrea Cortese Hassett, PhD
Published on line in April 2001
CLINICAL HISTORY:
The patient was a 77-year-old white male who presented to the Emergency Department with persistent nose bleeding. According to the patient, he woke up in the morning with a nosebleed which continued on and off during the day. He also reported multiple episodes of epistaxis in the past. The patient had a medical history of prostate cancer with bony metastasis, status post prostatectomy and hormonal therapy. Other medical problems included coronary artery disease, hypertension, stroke, and atrial fibrillation. His medications included: Atenolol, Prinivil, Ecotrin, Lasix, Zocor, and Duragesic patch. Physical examination on this patient was unremarkable except for some blood oozing from the nostrils and blood stains in the posterior oropharynx.
LABOARTORY FINDINGS:
The complete blood count and coagulation profile of this patient is shown in Table 1.
| Test | Value | Reference Range |
| HGB | 10.4 g/dl | 13.5-17.0 g/dl |
| HCT | 30.2 % | 40.5-50.0 % |
| WBC | 6.8 x 103/µl | 4.0-10.0 x 103/µl |
| Platelet | 157 x 103/µl | 140-440 x 103/µl |
| PT | 13.7 sec | 10.5-13.0 sec |
| PTT | 31.6 sec | 25-33 sec |
| INR | 1.2 | |
| Fibrinogen | 68 mg/dl | 150-350 mg/dl |
| Factor II | 0.85 U/ml | 0.60-1.40Uml |
| Factor V | 0.65 U/ml | 0.50-1.50 U/ml |
| Factor VII | 1.13 U/ml | 0.60-1.60 U/ml |
| Factor VIII | 0.65 U/ml | 0.50-1.50 U/ml |
| Factor IX | 1.40 U/ml | 0.60-1.35 U/ml |
| Factor X | 0.74 U/ml | 0.60-1.40 U/ml |
| Factor XI | 1.20 U/ml | 0.60-1.40 U/ml |
| Factor XII | 0.70 U/ml | 0.50-1.70 U/ml |
| FDP | 320.0 µg/ml | 0.0-2.5 µg/ml |
| D-Dimer | 64.0 µg/ml | 0.0-0.4 µg/ml |
| Antithrombin III | 91 % | 80-120 % |
| Plasminogen | 62 % | 80-150 % |
| Antiplasmin | 50 % | 80-120 % |
TREATMENT:
The patient was treated with Amicar (epsilon aminocaproic acid) in the Emergency Department with resolution of his bleeding. He was later discharged and scheduled for further chemotherapy to control his metastatic prostatic carcinoma.
FINAL DIAGNOSIS and DISCUSSION
