In a patient with prolonged PTT corrected by hemophilia A plasma, which condition is the most likely diagnosis?

• A. Factor V deficiency
• B. Von Willebrand disease
• C. Hemophilia B
• D. Acute DIC

Answer: (C)

In a scenario where a patient exhibits prolonged activated partial thromboplastin time (PTT) that corrects upon mixing with hemophilia A plasma, the most likely diagnosis is hemophilia B.

Hemophilia A is primarily caused by a deficiency in factor VIII, which is essential for the intrinsic and common pathways of the coagulation cascade and is the defect that allows for the correction after introducing normal factor VIII through hemophilia A plasma. When the patient's PTT is prolonged and is corrected by mixing with hemophilia A plasma, it indicates the presence of a deficiency in coagulation factors that are being corrected by the factor VIII present in the mixed plasma.

Hemophilia B, which is due to a deficiency in factor IX, would not correct the PTT when mixed with hemophilia A plasma, as hemophilia A plasma would lack the necessary factor IX to correct for that specific deficiency, thereby maintaining the prolonged PTT.

On the other hand, conditions like factor V deficiency or von Willebrand disease could also prolong PTT, but they would not present in the same way as hemophilia B, particularly in the context of the mixing study. Similarly, acute disseminated intravascular coagulation (DIC)