A 4-year-old boy develops a massive painful left knee swelling and a long history of gum bleeding.O/E there are two ecchymotic patches on the torso, and pallor. Hemogram showed Hb of 9gm%. Coagulation profile revealed PT of 11 sec, APTT of 92 sec. What is the most likely diagnosis of this patient:
Von Willebrand disease
Idiopathic thrombocytopenic purpura
Ans. A. Hemophilia A
The image here depicts a grossly swollen left knee. Along with the gum bleeding and bleeding elsewhere, it is most likely a hemarthrosis. This history along with an isolated prolonged APTT is suggestive of hemophilia. A further factor assay needs to be performed to confirm and differentiate between hemophilia A and B.