History

A 29 year-old man with history of hemophilia B presents to the Emergency Room (ER) with gross hematuria which began about one week prior. His symptoms progressed to the point where he was passing clots and urinating blood up to 15 times/day. He had one episode of severe right lower quadrant pain a day before his presentation to the ER. He reports 3-4 bleeds in the past that required factor IX replacement, primarily in his knee joints. He has no other medical problems and has never had surgery. He has a family history of hemophilia A. He is a non-smoker and drinks 1-2 beer each day. He works as a chef. He takes over the counter vitamin supplements, and has not known allergies to medicines.