MBBS OSCE · General Medicine
OSCE — Coagulation Disorders (Haemophilia & von Willebrand)
Eight-minute OSCE station on Coagulation Disorders (Haemophilia & von Willebrand): focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Coagulation Disorders (Haemophilia & von Willebrand).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Haemophilia A (factor VIII deficiency, X-linked recessive, F8 gene, 1 in 5000 males) and haemophilia B (factor IX deficiency / Christmas disease, F9 gene, 1 in 30 000 males) are the classic inherited coagulopathies, presenting with deep-tissue bleeds — haemarthrosis of knees/elbows/ankles, intramuscular bleeds, and (in severe disease) spontaneous intracranial haemorrhage. Von Willebrand disease (VWD) is the commonest inherited bleeding disorder (up to 1 in 100, autosomal dominant), causing mucocutaneous bleeding (menorrhagia, epistaxis, gum, dental). Diagnosis rests on a prolonged APTT with normal PT and platelets that corrects on mixing, confirmed by factor VIII/IX assays (haemophilia)
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Prolonged APTT with deep-tissue bleeding (haemarthrosis, muscle bleed) — haemoph |
| Safety | Intracranial haemorrhage in known haemophilia — emergency; give factor to 100 pe |
| Safety | Severe menorrhagia or recurrent epistaxis with family history — von Willebrand d |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.