Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 25 year old female who presents with the complaint of heavy vaginal bleeding.
HPI: Patient states that over the past few months she has noticed that her menstrual cycles have changed. They last 8 days instead of the usual 4, and she has begun soaking through pads every hour. Occasionally she notices that she is passing blood clots as well. During her menstrual cycles she is very fatigued, and has more cramping pain than she had previously. Prior to two months ago, her periods were always very regular. She recently stopped using her oral contraceptive as she and her partner are hoping to become pregnant.
PMH: No known drug allergies. No current medications. The patient’s medical history was significant for recurrent nose bleeds since 2 years of age, which occurred 2 to 3 times per month and typically lasted 10 to 15 minutes. These episodes of epistaxis were controllable at home and never required urgent medical intervention. She also had a history of easy bruising, although she had no evidence of joint bleeds
SH: Non-smoker. Married.
FMH: Mother has hypertension and diabetes. Father has hypertension and coronary artery disease.
ROS: Non-contributory
PE: Patient appears a bit pale, but otherwise in good health.
VS – Height 5’5” Weight 150lb BMI 25 HR82 BP110/75 RR16 98.5F
Cardiac – S1 and S2 audible. Regular rate and rhythm. No murmurs.
Lungs – Clear to auscultation bilaterally. No adventitious sounds present.
Abdomen – Soft, nondistended. Mild lower abdominal tenderness. No organomegaly present.
GU – Normal appearing labia majora and minora. Dried blood in vaginal vault.
Labs:
CBC – moderate anemia (hemoglobin 7.3 g/dL), a normal platelet count (200,000/μL)
Coagulation panel – normal PT (11 seconds) and PTT (32 seconds). PFA-100 results were abnormal with collagen-epinephrine and collagen-adenosine diphosphate (ADP), although these results were interpreted with caution because of the presence of anemia.