Patient History

A 48-year-old female was evaluated by her gynecologist for menometrorrhagia which she described as “almost continuous vaginal bleeding” over the past 4 months. She described heavy bleeding at her menses, with mild bleeding daily between periods despite hormonal treatment. Past medical history included episodes of gingival bleeding and epistaxis since childhood. She stated that these bleeding episodes constituted “more than that experienced by other people” in response to minor trauma, but usually stopped after 20 minutes or so. She denied easy bruising, purpura, petechiae, hematochezia, melena, hematemesis, hemoptysis, or had a history of bleeding into joints or soft tissues. While the patient denied any family history of known bleeding disorders, her mother had a periodic abnormally elevated activated partial thromboplastin time (aPTT) without any history of clinical bleeding. The patient was not taking any medications.