Fida Hussain, a 2 1/2 year old boy, was admitted to the emergency room with easy bruising since age 6 months. His past medical history included two blood transfusions for the same issue. Examination found multiple bruises of different sizes and ages. Initial testing found prolonged PT and APTT times. The differential diagnosis included von Willebrand disease, hemophilia, and thrombasthenia based on the history of easy bruising.

1. Nursery Total – 28 Adm – 7 Ward Total – 55 Admission – 8 . Bleeding diathesis . Bronchioloitis Emergency Total – 110 Male – 60 Female – 50 Admissions – 8 Discharge – 102 Received Dead – 0 OPD – 52 Short stay – 50 . Bronchiolitis . AWD . URTI

2. Fida Hussain s/o Iftikhar Ahmed, 2 1/2 years old young child, resident of Sialkot admitted via emergency with c/o : Easy bruisability – 2 years

3. According to mother, Child was alright 2 years back when he had gradual onset of easy bruisability at the age of 6 months . There is no history of fever, jaundice, hematemesis, malena, hematuria, epistaxis, gum bleed, prolonged bleeding from the circumcision wound, joint pains, oliguria, progressive pallor. There is history of prolonged bleeding from the site of wound, formation of bruises with minor trauma.

4. Past history : Patient was treated for the same problem at DHQ Sialkot with 2 blood transfusions 2 months apart and multiple investigations. Family history : No significant past history of such illness in the family, maternal uncles. No history of tuberculosis in the family. Drug History : Patient is taking anti-tuberculous therapy for last 7 months.

5. Birth history : Born via SVD at hospital uneventfully. Feeding history : Breast fed for 6 months. Patient is now on average family diet. Vaccination history : Patient is vaccinated according to EPI. Development history : Developmentally normal

6. Personal history : Child lives in a house with 2 rooms and 6 family members. Patient is 3 rd among the 4 siblings. All the others are normal. Examination : A young irritable child having multiple bruises of multiple sizes and different ages below the eyes, over the trunk and limbs. No pallor, jaundice, lymphadenopathy. HR = 102/min ; Resp = 30/min ; Temp = 99F CVS = S1 + S2 + with no abnormal sounds CNS = Intact GIT = No visceromegaly Resp = HVB + with no added sounds

7. Bruise

8. Bruise

9. Investigations : 23-04-11 : Hb 10.7g/dl, TLC 15,200/cmm Plt 8,53000/cmm, ESR 50mm/hr 29-10-11 : Hb 14.2g/dl, TLC 12,300/cmm Plt 6,41000/cmm, ESR 80mm/hr PT 46/14, APTT 64/36, INR 4.69 23-11-11 Hb 12.3g/dl, TLC 13,800/cmm Plt 5,05000/cmm, ESR 37mm/hr 25-11-11 Hb 12.2g/dl, TLC 8100/cmm Plt 6,0800/cmm, ESR 45mm/hr 05.01.12 Pt 13/13, APTT 45/33

10. 08-01-12 Hb 9.9g/dl, TLC 12,100/cmm Plt 5,46000/cmm PT 12/13, INR 0.96 Creatinine 0.8, Urea 37 Na 134mmol, K 4.1mmol Billirubin 1.1mg/dl, ALT 37U/l BT >8mins

11. Differential Diagnosis : . Von-Willibrand disease . Haemophilia . Thrombasthenia

12. THANK YOU !