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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Child with nose bleeding, epistaxis. Blood test showing high neutrophils, PTT. Coagulation factor activity low on Von willebrand panel. Advice?

Answered by
Dr. Robert Galamaga


Practicing since :2002

Answered : 2638 Questions

Posted on Thu, 28 Jun 2012 in Blood Disorders
Question: My son is 8 years old and has frequent nose bleeds, epistaxis. He was supposed to have the vein cauterized but his blood work came back abnormal. His absolute neutrophils are high, 9016 cells/uL, his activated PTT is high, 45 sec., his PT is normal, on his Von willebrand comp panel the coag factor VIII activity is low, 6, and his TT is high, 45 sec, factor IX activity clotting is normal. His lupus anticoagulant is neg, DNA DS antibody is neg, cardiolipin antibody screen is normal and his antithrombin III activity w/rfx to antithrombin III antigen is also normal. His only symptom is the frequent nose bleeds and a small petechia on his upper cheek bone that won't go away. He's a healthy boy he's 4ft 3in and weighs 78 pounds.
Answered by Dr. Robert Galamaga 6 hours later
Hello and thank you for submitting your question.

It appears that your son may have a type of hemophilia. Hemophilia is a disorder of quake elation which is caused by a deficiency in a coagulation factor number eight or VIII. It appears that his factor eight activity level is a diminished. It is important for his doctors to determine whether she has a true coagulation factor deficit or whether he has developed some type of inhibitor of his factor eight activity. This can be evaluated through a mixing study.

A mixing study is a routine test performed at eight quake elation laboratory. It may take several days for the results are returned. In some individuals they might acquire some inhibitor of the factor eight activity. I will provide you with a link to a very extensive article which describes hemophilia and the inhibitor which I had mentioned here. The link is as follows:

right now it is also important that your son's physicians establish his quake elation so that his bleeding improves or resolves. They will need to follow his platelet count as well.

I thank you again for submitting your question. I hope you have found my response to be helpful and informative. If you have additional concerns I would be happy to discuss them here.


Dr. Robert
Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Robert Galamaga 14 hours later
What about celiac disease? Can it cause the kind of lab results my son is having. My brother was recently diagnosed with celiac disease. I was tested last week for celiac disease. I'm just waiting on my results.
Answered by Dr. Robert Galamaga 58 minutes later
Hello and thank you for the follow-up question.

Regarding celiac disease I do not think that this would explain the issue that he is experiencing with coagulation. I suppose in a severe case of celiac disease it might cause some disturbance but I am not aware of this as a common phenomenon.

I think with the family history it is certainly worth checking. We will see what your test results show and then he can possibly be tested during the process of his further workup.

I thank you again for submitting your question. I hope you have found my answers to be helpful and informative. If you have any additional concerns I would be happy to address them here. Otherwise please except my answer.


Dr. Robert
Above answer was peer-reviewed by : Dr. Yogesh D

The User accepted the expert's answer

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