Differential Diagnosis for Vaginal Bleeding in a 12-year-old Girl
Single most likely diagnosis
- F) von Willebrand disease: This condition is a common cause of heavy menstrual bleeding in adolescents, especially those with a recent menarche. The patient's symptoms of prolonged and heavy menstrual bleeding, along with a normal prothrombin time and slightly elevated partial thromboplastin time, are consistent with von Willebrand disease.
Other Likely diagnoses
- B) Anovulatory menstrual cycles: Anovulatory cycles are common in the first year after menarche and can cause irregular and heavy menstrual bleeding. However, the significant thrombocytopenia and elevated partial thromboplastin time in this patient make anovulatory cycles a less likely primary cause.
- A) Acute lymphocytic leukemia: Although less common, acute lymphocytic leukemia can present with thrombocytopenia and bleeding symptoms. The patient's low platelet count and recent onset of heavy menstrual bleeding could be indicative of leukemia.
Do Not Miss diagnoses
- A) Acute lymphocytic leukemia: As mentioned earlier, leukemia is a critical diagnosis that should not be missed due to its severe consequences if left untreated.
- C) Factor XI deficiency: Although rare, factor XI deficiency can cause significant bleeding symptoms, especially in females with heavy menstrual bleeding. It is essential to consider this diagnosis to provide appropriate management.
Rare diagnoses
- D) Factor XIII deficiency: This is a rare bleeding disorder that can cause significant bleeding symptoms. However, it is less likely in this patient due to the presence of other more common causes of heavy menstrual bleeding.
- E) Hyperthyroidism: Hyperthyroidism can cause menstrual irregularities, but it is not typically associated with significant thrombocytopenia or coagulopathy, making it a less likely diagnosis in this case.