A 78-year-old patient recently noticed dark blotches on his ...

[maegan_martin]

A 78-year-old patient recently noticed dark blotches on his forearms and on the backs of his hands. He seems to bruise even when a phlebotomy is performed using excellent technique with no problems encountered.
 
  No other symptoms exist, and all laboratory tests are normal. Which of the following is the most likely diagnosis?
 
  a. Hereditary hemorrhagic telangiectasia
  b. Ehlers-Danlos syndrome
  c. Paraproteinemia and amyloidosis
  d. Senile purpura

Question 2

Which of the following is true regarding testing for the diagnosis of vascular disorders?
 
  a. Most do not have abnormal clinical laboratory tests.
  b. The platelet count and aggregometry are useful.
  c. The prothrombin time (PT) and partial thromboplastin time (PTT) are most useful.
  d. Evaluation of von Willebrand factor (VWF) is useful.

[ebe]

Answer to Question 1

ANS: D
Senile purpura is the most likely diagnosis for this 78-year-old man who only recently began to notice abnormal bruising and/or bleeding. The hereditary abnormalities would have presented earlier in life. Paraproteinemia and amyloidosis would demonstrate other abnormal clinical laboratory testing.

Answer to Question 2

ANS: A
Clinical laboratory tests are not available for evaluation and diagnosis of vascular disorders. Ruling out other sources of bleeding disorders often makes the diagnosis. The usual clinical signs are easy bruising and spontaneous bleeding, especially from mucosal surfaces. In that respect they are similar to platelet dysfunction disorders.