Online Cases 3-29-11 Tues

Online Cases 3-29-11 Tues - Online Cases 3-29-11....

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Online Cases 3-29-11. Thrombosis I. HISTORY Patient Presentation A 20-year-old college student returned to the U.S. following a summer break in which she traveled and hiked extensively in New Zealand. Two days after her flight she awoke with swelling and pain in her left calf and thigh and noticed that the skin of the leg appeared dusky blue in color. Because of these rather alarming symptoms, and the fact that her mother had a blood clot when she was young, she came immediately to the emergency room where noninvasive venous studies showed an extensive deep venous thrombosis involving the popliteal, femoral and iliac veins on the left. Should this patient be evaluated for an underlying thrombophilia? Yes Good choice! COMMENT: This patient shows signs of an underlying thrombophilia or procoagulant state. The long plane flight could have provoked the clot, but since most people who take long flights do not get blood clots, we interpret this as “unprovoked”. The four main signs of a procoagulant state are: Thrombosis at an early age. Recurrent thromboses. Thrombosis in an unusual site. Family history of thrombosis. No. Incorrect. Try again. Review of Procoagulant States Common Risk Factors for Thrombosis There are many general risk factors for thrombosis that need to be excluded first in any patient who presents with thrombosis. 1. Obesity 2. Inactivity 3. Pregnancy 4. Estrogens/Birth Control Pills 5. Post-surgery 6. Malignancy Once the common risk factors are excluded, inherited risk factors should be considered. In the patient presented in this case, none of the above considerations are what we call “clinically relevant”, except, perhaps, a long airplane trip returning home and inactivity associated with it. However, most people who take long plane flights do not get blood clots, so in our clinical judgment, the thrombosis is “unprovoked” Click here for more details about these risk factors. Inherited Procoagulant States
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Inherited Procoagulant States Defect Incidence in Population Percent of Patients with Procoagulant States 1. Factor V Leiden 5-10% 20-60% 2. Prothrombin Gene Mutation 2-4% 6-8% 3. Homocysteinemia -- 10% 4. Protein C Deficiency 1:200 <5% 5. Protein S Deficiency -- <5% 6. Antithrombin Deficiency 1:2-5,000 <1% 7. Dysfibrinogenemia Not known ~1-2% 8. Elevated Lipoprotein(a) -- -- Click here for details about these procoagulant states. Acquired Prothrombotic Medical States 1. Antiphospholipid antibody syndrome 2. Disseminated intravascular coagulation. 3. Heparin-induced thrombocytopenia and thrombosis syndrome. 4. Inflammatory bowel disease 5. Myeloproliferative disorders 6. Nephrotic syndrome 7. Paroxysmal nocturnal hemoglobinuria (PNH) Click here for details about these acquired prothrombotic medical states.
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I. HISTORY What symptoms or history might be helpful in making the diagnosis? Consider each of the following and click on the questions you believe will be most helpful in this case. Do you have any illnesses?
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This note was uploaded on 09/14/2011 for the course PHARM HEM taught by Professor Staff during the Spring '11 term at UCSD.

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Online Cases 3-29-11 Tues - Online Cases 3-29-11....

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