An 84-year-old woman with a history of chronic kidney disease, prior stroke, and hypertension was admitted with a 2-week history of spontaneous subcutaneous ecchymoses and hematomas. She did not have any history of bleeding disorders, preceding trauma, or other precipitating factors such as recent heparin exposure, surgical procedures, underlying liver disease, or receipt of anticoagulation agents. There was no family history of hematologic disorders.
Her vital signs were normal. Physical examination showed large ecchymoses on the left arm, right shoulder, left anterior chest wall, and flank. Initial laboratory results showed isolated severe anemia. Computed tomographic imaging showed a large soft-tissue hematoma in the left chest wall without evidence of internal hemorrhage. Test results for other causes of anemia were unremarkable. Laboratory values and mixing study results are shown in the Table.
Choi S, Rambally S, Shen Y. Mixing Study for Evaluation of Abnormal Coagulation Testing. JAMA. 2016;316(20):2146–2147. doi:10.1001/jama.2016.15749
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