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Underlying neoplasm or septic emboli were also excluded. Lupus anticoagulant, antiphospholipid and anticardiolipin antibodies, and homocystinuria were negative. The screening test for factor V Leiden was negative.
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Von Willebrand multimeric analysis was normal, which is consistent with a type I pattern. Coagulation factor tests showed factor VIII 28.9% (our laboratory normal 60–140%), von Willebrand factor (vWF)‐related antigen 35% (normal 50–160%), vWF ristocetin cofactor 32.2% (normal 60–170%), factor XI 83% (normal 60–140%), protein S 81.8% (normal 55–140%), and protein C 98% (normal 60–150%). Prothrombin time was 100% (INR ratio 1.0) and partial thromboplastin time was 36.0 s (laboratory normal 34–38 s). Bleeding time was 6 min and clotting time was 7 min. Lactic dehydrogenase, creatinine phosphokinase, and proteinuria normalized during hospitalization. Serum chemistries were remarkable for elevated aspartate aminotransferase (56 U/l), alanine aminotransferase (54 U/l), lactic dehydrogenase (839 U/l) (predominantly LDH‐2 isoenzymes), and creatinine phosphokinase (380 U/l). Urinalysis showed many red blood cells per high‐power field and 2+ proteinuria, but was negative for white blood cells, crystals, and casts culture was negative. Physical examination revealed lower left abdominal tenderness.
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On admission, the patient's blood pressure was 120/80 mmHg, supine pulse 70 b.p.m., and axillary temperature 36.8☌. There was no personal or family history of diabetes, hypertension, or renal disorder. The patient, her mother, and her mother's brother had histories of prolonged bleeding episodes and easy cutaneous bruising. The pain started 5 days before admission and was unremitting. Case.Ī 16‐year‐old girl was admitted with gross haematuria and recent onset of pain, without radiation, in the right costolumbar area. However, renal infarction in vWD has not previously been reported in the English literature. There are some reports of thrombosis in vWD: one case of deep‐venous thrombosis and pulmonary embolism in a patient with type III vWD and protein C and antithrombin III deficiency, and one case of spontaneous platelet aggregation during pregnancy in vWD type IIB have been published. Common symptoms include bleeding after surgery, spontaneous epistaxis, menorrhagia, and gastrointestinal or genitourinary bleeding. Because vWD is heterogeneous there are variable manifestations. Von Willebrand disease (vWD) is the most common inherited bleeding disorder.