A boy with mild haemophilia A and eosinophilia-induced platelet dysfunction

A 14-year-old boy presented with a recent onset of spontaneous ecchymosis and epistaxis. Investigations revealed moderate eosinophilia with normal platelet count, hypogranular platelets in peripheral blood smear, and prolonged bleeding time, suspected the possibility of acquired platelet dysfunction with eosinophilia (APDE). He was also found to have persistent marginally prolonged APTT, which created a diagnostic challenge. The bleeding symptoms, eosinophilia, bleeding time, and platelet hypogranularity resolved with a full course of anti-helminthic treatment supporting the diagnosis of APDE. Coagulation factor assay revealed marginally low factor VIII levels with normal von Willebrand antigen assay and activity; hence the diagnosis of asymptomatic mild haemophilia A was made.