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75 year old woman, fell & sustained a R hip fracture.

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75 year old woman, fell & sustained a R hip fracture.

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  1. 4 year old boy comes in with painful, swollen R ankle after having fallen off of a swing 6 hours previously, landing on his knee. No history of bruising; no prior history of ER visits. Knee is markedly swollen & painful to the touch. Family history positive for a maternal uncle with mild hemophilia A; mother has never been tested. X-rays of knee show joint effusion but no other fractures.

  2. 45 year old woman admitted for hysterectomy for menorrhagia and fibroid tumors. History reveals that she has never had surgery or tooth extractions in the past, but that she has a brother with factor XI deficiency, who recently won a large lawsuit after having had a major postoperative bleed. His preop aPTT was prolonged, but it was missed until post-op.

  3. 60 year old man, 2 weeks post-op for Bilroth II for peptic ulcer disease, complicated by episode of septic shock 4 days post-op, now oozing from wound site. Has been on broad-spectrum antibiotics x 10 days; no PO intake & no TPN x 2 weeks.

  4. 93 year old woman who comes in with a spontaneous soft tissue bleed into the R side of her neck and face. NO past history of bleeding; no history of falling. Initial evaluation in ER reveals a 2x3 cm lesion on the L side of her face, suspicious for a squamous cell tumor, NOT connected in any way to the soft tissue bleed on the R side. Admitted to ENT service for removal of that lesion. • Meds - None

  5. 40 year old man, c/o severe pain & swelling of R knee. Patient has family history of gout, & saw rheumatologist, who tapped the knee, getting straw colored fluid out. After the tap, he told her, "Oh, by the way, I have a history of von Willebrand disease." Placed on non-steroidal drug for presumed gout (uric acid in past was elevated). Pain initially subsided, but is now much worse, with severe swelling. Retap of knee reveals blood.

  6. 53 year old woman referred to you following a L breast biopsy that resulted in a hematoma from axilla to iliac crest on left. Biopsy was benign fibrocystic disease.

  7. 21 year old man who has a history of hemophilia B, with factor IX levels of 8%, who comes in with a 3 day history of maroon stools. Had been given Naprosyn for a leg injury 5 days earlier. • WBC 5.8 • Hgb 7.5 • Hct 23 • Plt 345,000 • Stool: Grossly bloody

  8. 75 year old woman, fell & sustained a R hip fracture. • PMH - Paroxysmal A fib, Rx Digoxin; Osteoarthritis Rx Naprosyn prn (last dose 5 days ago). Otherwise well. • LAB  • CBC: WBC 10.5, Hgb 11.0, Hct 32, MCV 85, Plt 275,000 • ABG - WNL • PT 11.5 (normal 10.5-12.5) • aPTT 45.2 (normal 20-30) • Orthopedic surgeon calls @ 5:00 pm & says she is on the OR schedule for 7:30 tomorrow morning, and that you HAVE to fix her coags by then so he can operate.

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