Q:

A 3-year-old female child with repeated admissions as bleeding tendency in a form of spontaneous ecchymosis and bleeding through the nose and urine

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 A 3-year-old female child with repeated admissions as bleeding tendency in a form of spontaneous ecchymosis and bleeding through the nose and urine. She had another daughter who died because of similar undiagnosed illness. The mother is a staff nurse and she is highly concerned about her child illness. Lab investigations usually show»l either PT and/or PTT prolongation with normal platelets, which usually normalized after empiric vitamin K administration. The fatherIs a petrol engineer and never seen accompanying the family. Of the following, the MOST helpful investigation is


  1. factor VII assay
  2. factor II assay
  3. drug level
  4. von Willebrand factor assay
  5. platelets function test

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(C) The presentation of medical child abuse (MCA) formerly called Munchausen syndromeby proxy;may vary in nature and severity. Consideration of MCA should be triggered when the reported symptoms are repeatedly noted by only one parent, appropriate testing fails to confirma diagnosis,and seemingly appropriate treatment is ineffective. Drug level for warfarln may solve the problem in this case, the mother is staff nurse and she is familial with medical issues,the social history given issuggestive of disturb relationship between parents

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