A 55-yr old male with biopsy, confirmed with adenocarcinoma of the colon, was admitted for surgery. The patient had been bleeding into the GI tract for the past 10 days. The medical history was significant for epistaxis and hypertension. The nosebleeds lasted more than 12 minutes but require no medical treatment. The patient states that he bleeds a lot from cuts, but wounds heal normally. He is unaware of family history of bleeding. The physician ordered a PT, PTT and CBC.
Test
Result
Reference Range
WBC count
11.2 x 10^9/L
4-11 x 10^9/L
RBC count
3.22 x 10^12/L
4.50-5.50 x 10^12/L
HGB
10.2 g/dl
12-15 g/dl
HCT
31.6%
35-45%
MCV
98 fl
80-99 fl
MCH
31 pg
25-32 pg
MCHC
32.8%
32-36%
PLT
166 x 10^9/L
150-450 x 10^9/L
Differential
Differential
Differential
Segmented Neutrophils
53%
50-70%
Bands
8%
0-5%
Lymphs
27%
20-40%
Monos
7%
2-10%
Eos
4%
2-4%
Metamyelocytes
1%
0%
PB smear
Normocytic normochromic with slight anisocytosis
Normocytic Normochromic with slight anisocytosis
Given the positive BAT result, coagulation tests were ordered, and the results are below:
Test
Result
Reference Range
PT/INR
11.6 sec
10-14 sec
INR
1.5
2.5-3.5
APTT
46 sec
23-35 sec
Please answer the questions below:
List all the significant findings of this case (both in the clinical presentation and in the laboratory values) and explain why they are significant. There are at least 5 in each category (clinical presentation and laboratory values).
Based on the clinical and laboratory presentation of this case, what diseases are you suspecting. Name at least 2 disorders that you suspect.
What lab tests would you run to confirm one disorder and rule out the rest of the suspecting disorders?
Predict the laboratory values on the confirmatory tests that will support your final diagnosis?
What is your final diagnosis?
Propose a pathophysiologic mechanism of this disease that produced the provided results.
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