case study of a 62 year old female with postoperat
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Case Study of a 62-year-old Female with Postoperat
Case Study of a 62-year-old Female with Postoperat
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Case Study of a 62-year-old Female with Postoperative Bleeding and
Persistent Abnormalities on Platelet Aggregation Studies.
Case Presentation
A 62-year-old female presented with a concerning palpable mass in her right breast in January
2008. The patient elected to undergo a lumpectomy, which was followed by a right modified
radical mastectomy and axillary lymph node dissection. The right breast mastectomy was
complicated by post-operative bleeding requiring transfusion of 1 unit of packed red blood cells
(ISTH-BAT score 4). The patient’s past medical history was significant for easy bruising (ISTH-
BAT score 1), frequent nosebleeds (ISTH-BAT score 1), heavy menstrual periods (ISTH-BAT
score 1) and a history of a hematoma of the left thigh following an injury (ISTH-BAT score 1).
The patient’s total ISTH bleeding score was 8 (normal range is <4 in adult males, <6 in adult
females and <3 in children).
Her family history was significant for easy bruising and frequent nosebleeds in her mother. The
patient had no siblings or children. The only medication the patient was taking was
levothyroxine (Synthroid) and her TSH was normal. She was not taking antiplatelet medication
or over the counter medications.
Due to her history of increased mucocutaneous bleeding symptoms, perioperative bleeding
requiring blood transfusion, high ISTH bleeding score and family history she underwent
laboratory testing in March 2008 which included a CBC with platelet count, peripheral blood
film, prothrombin time (PT), activated partial thromboplastin time (aPTT), von Willebrand
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profile and closure times with collagen/ADP and collagen/EPI, all of which were normal.
Platelet aggregation studies by light transmittance aggregometry on platelet rich plasma were
abnormal with ADP only (Table 1). Repeat platelet aggregation studies in April 2008 (Table 2)
demonstrated persistent abnormalities on platelet aggregation studies with ADP only, but
adenine nucleotide testing for delta-storage pool deficiency was normal. Following persistent
abnormalities on platelet aggregation studies, the diagnosis of a platelet function defect was
rendered, however whether the disorder was inherited or acquired was not discernible. She had
no spontaneous bleeding and was not planning any surgeries. She was recommended to be
reevaluated prior to surgeries in the future.
In January of 2024, the patient returned for care with an anticipated fistulectomy and hip
replacement in the future. Her previously diagnosed hypothyroidism was well controlled, and she
denied any episodes of spontaneous bleeding. Of note, the patient underwent an incision and
drainage for a perianal abscess and recovered successfully without any post-operative bleeding
complications. Due to her anticipated need of multiple surgical procedures and her history of
qualitative platelet dysfunction, she was referred to hematology. Repeat platelet aggregation
study results were similar to those previously done in 2008 with decreased platelet aggregation
response to ADP only (Figure 1) and adenine nucleotide ratio was again normal. Patient samples
were sent for platelet granule storage and release testing by flow cytometry (Table 3).
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