Question

A young patient presents with a large retroperitoneal hemorrhage. He also gives a frequent history of intermittent swelling of knees on strenuous exercise. There is no history of any mucosal bleeding. Which among the following clotting factors is responsible for the condition mentioned above ?

• A. Factors VIII and IX
• B. Factors XI and XII
• C. Von Willebrand factor
• D. Lupus anticoagulant

Answer 1

The Correct Option is A

A young patient presenting with a large retroperitoneal hemorrhage and a history of intermittent swelling of knees after strenuous exercise suggests an underlying bleeding disorder related to clotting factors. The absence of mucosal bleeding helps narrow down the possibilities. The key characteristics to consider are: 

1. Retroperitoneal Hemorrhage: This indicates significant bleeding, often associated with deep tissues, which is characteristic of hemophilia.
2. Intermittent Swelling of Knees: Joint bleeding, or hemarthrosis, is common in certain types of hemophilia.
3. Absence of Mucosal Bleeding: Suggests the bleeding disorder is more related to clotting factor deficiencies rather than platelet dysfunction or von Willebrand disease.

Among the options, hemophilias A and B are commonly caused by deficiencies in Factor VIII and IX, respectively. Both these factors are involved in the intrinsic pathway of the clotting cascade, which is particularly important in the type of bleeding observed.
The disorders associated with:

• Factor VIII: Hemophilia A
• Factor IX: Hemophilia B

These conditions match the patient’s symptoms of large hematomas and hemarthrosis without mucosal bleeding, as typically seen in platelet-related defects or von Willebrand disease.

 

In conclusion, the patient likely has a condition involving a deficiency in either Factor VIII or IX, making Factors VIII and IX the most appropriate answer. This aligns with common hemophilia presentations.