Which condition presents with normal prothrombin time, prolonged partial thromboplastin time, prolonged bleeding time, and normal platelet count?

Which condition presents with normal prothrombin time, prolonged partial thromboplastin time, prolonged bleeding time, and normal platelet count?

• A. Von Willebrand disease
• B. Haemophilia
• C. Thrombocytopenia
• D. Aspirin

Answer: (A)

When a test pattern shows normal prothrombin time, prolonged activated partial thromboplastin time, prolonged bleeding time, and a normal platelet count, it points to a defect that affects both platelet adhesion and factor stability, rather than a simple platelet quantity issue or a pure clotting-factor deficiency alone. Prothrombin time staying normal means the extrinsic pathway is fine. Prolonged aPTT indicates a problem with the intrinsic pathway or with factors whose function is supported by von Willebrand factor (vWF), such as factor VIII. Prolonged bleeding time reveals a platelet adhesion/aggregation problem, and a normal platelet count tells you platelets are being produced but aren’t functioning properly. In von Willebrand disease, there is deficient or defective vWF, which impairs platelet adhesion to damaged vessel walls and also reduces the stability of factor VIII, leading to a longer aPTT. Since the extrinsic pathway and platelet numbers are unaffected in this scenario, PT remains normal and platelet count stays normal. In contrast, haemophilia would raise aPTT without prolonging bleeding time, because the issue is a clotting factor defect with normal platelet function. Thrombocytopenia would show a low platelet count, and aspirin would prolong bleeding time due to platelet dysfunction but typically does not prolong aPTT. So the combination described best fits von Willebrand disease.

When a test pattern shows normal prothrombin time, prolonged activated partial thromboplastin time, prolonged bleeding time, and a normal platelet count, it points to a defect that affects both platelet adhesion and factor stability, rather than a simple platelet quantity issue or a pure clotting-factor deficiency alone. Prothrombin time staying normal means the extrinsic pathway is fine. Prolonged aPTT indicates a problem with the intrinsic pathway or with factors whose function is supported by von Willebrand factor (vWF), such as factor VIII. Prolonged bleeding time reveals a platelet adhesion/aggregation problem, and a normal platelet count tells you platelets are being produced but aren’t functioning properly.

In von Willebrand disease, there is deficient or defective vWF, which impairs platelet adhesion to damaged vessel walls and also reduces the stability of factor VIII, leading to a longer aPTT. Since the extrinsic pathway and platelet numbers are unaffected in this scenario, PT remains normal and platelet count stays normal.

In contrast, haemophilia would raise aPTT without prolonging bleeding time, because the issue is a clotting factor defect with normal platelet function. Thrombocytopenia would show a low platelet count, and aspirin would prolong bleeding time due to platelet dysfunction but typically does not prolong aPTT.

So the combination described best fits von Willebrand disease.