let go of your inhibitions!

Today we developed a great illness script for a patient with a severe acquired factor VIII inhibitor.

Elderly woman who presents with non-traumatic ecchymosis, hemarthrosis, and soft tissue hematoma found to have prolonged PTT and mixing study suggestive of a factor inhibitor diagnosed with an acquired factor VIII inhibitor treated successfully with prednisone.

3 learning points:
1. If you diagnose an acquired factor inhibitor -- look for a reason like cancer.
2. Exam findings suggestive of thrombocytopenia are petechiae (capillary hemorrhages) and mucosal bleeding vs exam findings suggestive of coagulation disorders are large palpable ecchymoses, large, spreading, deep soft tissue hematomas, and hemarthoses.
3. When a mixing study is performed, if the PT or PTT remains prolonged, it is suggestive of a factor inhibitor being present.