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Anemia, easy bruising and tiredness, low platelets and von willebrands,adviced prenatal and antibody screening. Why prenatal ?

Answered by
Dr.
Dr. Aashish Raghu

Orthopaedic Surgeon

Practicing since :2011

Answered : 5177 Questions

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Posted on Thu, 7 Jun 2012 in Blood Disorders
Question: Gender: Female
Age:21
History of anemia
went to my doctor because I was bruising easily and finding I was consitantly tired and she ordered blood work (TSH, CBC, and Von Willebrands), when it came back it showed low platelets 139 (norm 150-400) and the von willebrand fact antigen came back at 0.54 U/ml (norm 0.55-1.81) and the factor VIII activity came back at 0.63 U/ml (norm 0.64-1.76). (ferritin was 22 ug/L (norm) and hemoglobin and hematocrit were normal at this time) My doctor said I may have a blood disorder and reordered a CBC and the von willibrands, as well as immunology- prenatal : ABO, RhD, Antibody Screen. And told me not to take any NSAIDS or asprin or birth control which could affect the test but I am fairly certain I hadnt taken any of these in the 2 weeks prior to the first blood test.

I dont understand why the prenatal part was odered im assuming because of the antibody screen and with the platlets being low and the von willebrands being low im not sure where her thinking is going and she has left for holidays and me with no explaination... I was just wondering what your thoughts are based on the information
Thanks
doctor
Answered by Dr. Aashish Raghu 28 minutes later
Hi,

Thanks for the query.

I have read your problem. I understand that you suffered from easy bruising.

Since when did you discover the fact that your bruise easily?
Have you had any fever at that time?
Do you pass black stools, or have heavy periods?
Any shortness of breath, dizziness?
Do your parents, cousins have a similar problem?

It is possible you are having a blood disorder which affects bleeding and possibly clotting function. There could be many reasons for this abnormal test result, like hereditary deficiency of Von Willebrand factor (vWF) and even Factor VIII.
You still need to do a few tests like Bleeding time, Clotting time (aPTT, PT, INR), Ristocetin induced platelet aggregation test may be required. Avoid drinking Cranberry juice or eating ginger and garlic as it may have effect on bleeding and clotting parameters.

The prenatal ABO Rh D antibody screen would have to be done to rule out possible causes of antibody induced damage to the platelet cells and other clotting factors which are involved in clotting mechanism in the blood, like Lupus anticoagulant, Anti-cardiolipin antibody screen etc.

The platelets being low suggests possibly the cause of low Von Willebrand factor as well. A thorough checkup and required tests are entailed to come to a conclusion on the diagnosis.

Eat healthy. Drink plenty of water. Eat fresh fruits and XXXXXXX leafy vegetables. Exercise daily to keep fit. Stay stress free, do Yoga as well. Stress can also cause such problem in clotting.

Do get the required investigations as mentioned above as soon as your Doctor is available and a thorough clinical examination to find the cause of this problem, s that a diagnosis can be reached and appropriate treatment can be given according to the cause.

Mild cases of vWF can be treated by Desmopressin inhalation under medical supervision. Sometimes Factor VIII concentrate may be administered depending on the severity of the disease. Not to worry. Once proper diagnosis and cause is ascertained appropriate management can be given.

I hope I have answered your query. I will be available to answer your follow up queries.

Regards,


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Aashish Raghu 3 hours later
Thank you for the information so far to answer you questions, I have bruised easily since at least the age of 13-14 and was told it was because of the anemia which my told said would be because I do have heavy periods. I do get dizzy and fainted once during the summer agin I was told that it was probably because I was anemic.

There is not blood in my stool, no SOB and no fever associated with any of the symptoms.

I do have one incidence of a possible blood disorder that affected my great grandmother, the only information I have is that at the end of her life 63 for the last couple of years she bruised very badly, had frequent severe nose bleeds and had to recieve regular blood tranfusions. Because of the lack of medical knowledge avaliable she was never diagnosed with anything but according to my grandmother the from the onset of these symptoms she declined and then passed away.

My doctor did do clotting times in the intial blood work and they all came back within normal ranges INR: 1.0 ref range (.9-1.2), and aPTT 32.4 seconds.

doctor
Answered by Dr. Aashish Raghu 21 minutes later
Hi,

You have not mentioned the normal value for aPTT. I cannot confirm unless you let me know the normal range according to the laboratory parameters.

Anaemia does not cause bruising. Although anaemia can be associated with bruising if there is small blood vessel disorder where red cells and platelets are destroyed. It may be good if the cause for anemia is also evaluate as you do the tests for blood disorders
Is your diet lacking iron?
Eat plenty of XXXXXXX leafy vegetables and continue on iron. I would recommend that you do a Peripheral blood smear and also tests to find out what kind of anaemia you have as not all anaemias are due to iron deficiency.

Since your Grandmother appears to have been suffering from bleeding disorder, it could be a familial disease like nose, gastrointestinal tract so that indicates it is not severe variety of the disease.

Do discuss various tests like Ristocetin platelet aggregation test which can help diagnose vWF deficiency and also Platelet assay tests.

Once diagnosis is made, appropriate treatment can be given.

Avoid accidents, bumping into objects as much as possible because it is possible that your blood vessels are weak at forming strong clot and can bleed easily. Eat plenty of fresh fruits to prevent Vitamin C deficiency as Vitamin C is needed to strengthen the blood vessels as well.

Hope this helps.

Wishing you good health.

Regards

Above answer was peer-reviewed by : Dr. Prasad
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