) Haemostasis and thrombosis


A 78-year-old man visits his general practitioner (GP) with a short history of widespread bruising. He has a history of type 2 diabetes mellitus, atrial fibrillation and monoclonal gammopathy of uncertain significance. You are contacted by the GP whilst on-call later in the evening. He is seeking advice regarding the following results.



104 g/l

White cell count

6.4 x 109/l


169 x 10 9/l

Clauss fibrinogen

3.4 g/l

Prothrombin time

12 s

Activated partial thromboplastin time

84 s

PT= Prothrombin time, APTT= Activated partial thromboplastin time

Question 1

Give a differential diagnosis based on your interpretation of the clinical and laboratory information.


Question 2

What further investigations should be undertaken? 

Question 3

Outline your immediate management of this patient.


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