Sub-conjunctival Hemorrhage Following a Bout of Cough: A Harbinger of Underlying Bleeding Diathesis

Excerpt

To the Editor: A five-year-old girl presented with red eyes for 15 d following a brief bout of cough illness. There was no pain, itching or watering of eyes or diminution of vision. There was no history of bleeding from any other site and no history of recent trauma. However, there was a history of prolonged bleeding from the umbilical stump in the neonatal period and also following trivial trauma in the past which had been forgotten. She was born out of a non-consanguineous marriage with no family history of bleeding diathesis. Examination revealed bilateral sub-conjuctival hemorrhage (Fig. 1). Clinical examination was otherwise unremarkable. Investigations revealed Hb of 9.3 g/dl, platelet count of 508,000/cu.mm, Prothrombin time (PT): > 240 s (INR >4); activated Partial thromboplastin time (aPTT): > 240 s; Thrombin time (TT): >180 s. Liver function test (LFT) was normal. A diagnosis of congenital fibrinogen deficiency was suspected. Serum fibrinogen level was 29 mg/dl (normal value 200–400 mg/dl). In the hospital she developed prolonged bleeding from the venepuncture sites which subsided with two units of fresh frozen plasma. At two weeks follow-up, the sub conjunctival hemorrhage had completely resolved.

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