Differential Diagnosis

The patient presents with persistent bleeding after a wisdom tooth extraction, easy bruising, and heavy menstrual cycles. Laboratory results show a prolonged activated partial thromboplastin time (aPTT) and low factor VIII activity. Based on these findings, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Hemophilia A: This is a genetic disorder caused by a deficiency in factor VIII, a crucial protein for blood clotting. The patient's symptoms, including prolonged bleeding after a surgical procedure, easy bruising, and heavy menstrual cycles, are consistent with hemophilia A. The laboratory results showing a low factor VIII activity level further support this diagnosis. The patient's mother having a bleeding disorder also suggests a possible familial component, which is common in hemophilia A.
• Other Likely Diagnoses
  • Von Willebrand Disease: This is another common bleeding disorder that affects the blood's ability to clot. It is caused by a deficiency or dysfunction of von Willebrand factor, which is important for platelet adhesion and protection of factor VIII. The patient's symptoms of easy bruising and heavy menstrual cycles could be consistent with von Willebrand disease, although the specific laboratory findings would need to include tests for von Willebrand factor activity and antigen levels.
  • Factor XI Deficiency: This is a rare bleeding disorder that could present with similar symptoms, especially if the deficiency is severe. However, it is less likely given the specific mention of low factor VIII activity.
• Do Not Miss Diagnoses
  • Disseminated Intravascular Coagulation (DIC): Although less likely given the clinical context, DIC is a serious condition that can cause both bleeding and clotting due to the consumption of clotting factors. It would be critical to rule out DIC, especially if there were signs of systemic illness or other organ involvement.
  • Severe Liver Disease: Liver disease can lead to a deficiency in clotting factors, resulting in bleeding tendencies. However, there are no specific indications of liver disease in the provided scenario.
• Rare Diagnoses
  • Factor XIII Deficiency: This is a very rare bleeding disorder that affects the stabilization of blood clots. Patients with factor XIII deficiency may have a history of delayed bleeding after trauma or surgery.
  • Glanzmann's Thrombasthenia: A rare platelet disorder characterized by the inability of platelets to aggregate, leading to bleeding. However, the normal platelet count and the specific symptoms related to clotting factor deficiencies make this less likely in this scenario.

Each of these diagnoses should be considered in the context of the patient's clinical presentation, family history, and laboratory findings to determine the most appropriate diagnosis and treatment plan.