Judging clinically: A case of bleeding from mouth, ecchymosis, pallor and shock

The boy was brought to the ward with profuse and fresh bleeding from the mouth for a day. His mother told that he had the same episodes of bleeding 5 to 6 times since birth but never so profuse and no history of hemarthrosis. One of his maternal uncles died from uncle bleeding at the age of 25 years.

He was deadly pale and in shock Few ecchymoses were also found on the lower limbs of the body. He had no fever, no lymphadenopathy, no hepatospelomegaly and no bony tenderness.

We thought the case as Hemophilia. The patient recovered after getting two bags of fresh blood.

Patient’s investigations revealed normal BT, CT and Platelet Count. He had leucocytosis and neutrophilia probably due to acute hemorrhage. Blood his blood film reveals Plasmodium Vivax. Our MRCP Colleague preferred to give him a course of Chloroquine at the same time.

With normal BT, CT the patient may be a case of von Willebrand Disease, Type –I, instead Hemophilia.

The patient was also given inj caprolysin locally in the oral cavity. The patient was also given Trianexamic acid orally. Cryprecipitate containing VWF is not available here as well Desmopressin.

Regarding malarial infection, malaria will not cause bleeding unless it produces DIC in extremely critical cases, that is also related with Plasmodium falciparum, not related with vivax. Could there be a concomitant infection of malaria along with bleeding diathesis? There must have been warning sign such as fever, headache, voming etc for malaria to be present as a parallel disorder in this particular patient.


Badrud Doza.