A 7 1 -year-old woman presents with I day of headache and left-sided weakness after complaining for several days of dyspnea and confusion. Her history is notable for nonvalvular atrial fibrillation and hypertension; she denies any prior history of thrombosis or bleeding. Her medications include a beta-blocker and warfarin (coumadin). Examination is notable for partial left hemiplegia; ecchymoses are noted over both forearms. The remainder of the examination demonstrates rales over both lung bases, an irregularly irregular heart rhythm, and a heave at the left sternal border. CBC: Hemoglobin/hematocrit – 12 g/dU35% MCV – 89 fL MCH – 30 pg MCHC – 27 g/dl RDW-CV – I 0% WBC count 6,500/gL Platelet count – 225,000/!!L PT = 55.1 seconds (< 14=”” seconds)=”” inr=”7.” 1=””>< 1.3)=”” ptt=”39″ seconds=”” (22-35=”” seconds)=””>
Questions
• Do the screening coagulation test results point to a specific cause for a bleeding tendency in this patient?
• Are additional studies warranted for diagnosis or determining therapy?
