Hello doctor, A 49-year-old patient presented with acute vein thrombosis of the lower extremities. He was admitted for acute bilateral swelling following a three-month course of hematoma formation and one episode of spontaneous hematuria. On admission, the patient is pale with multiple cutaneous hematomas in the right forearm, posterior aspects for both lower extremities are swollen and a positive Homans sign is elicited upon palpitation of the gastrocnemius. WBC is 5.5, the differential count is all normal except neutrophil is increased, lymphocyte is decreased. Hematocrit is 49 %, platelet is 56,000, coagulation studies shows prothrombin normal, APTT prolonged, fibrinogen 177 mg/dl, FSP/FDP positive, mixing studies no correction. I would like to ask help for the exact diagnosis and the treatment. Also, I want to ask for explanation or discussion on the diagnosis.
Hello. The APTT (activated partial thromboplastin time) test is positive (attachment removed to protect patient identity). So three causes should be ruled out: Mixing test for APTT is not corrected, so lupus inhibitor seems to be more likely. For rule out above causes factor 8 and other intrinsic factor coagulation assay, antiphospholipid antibody estimation can be done. For an acute thrombotic event, low molecular weight heparin is prescribed. Then oral anticoagulant like Rivaroxaban can be prescribed as maintenance therapy for two to three months. You should consult a hematologist for examination and coagulation profile workup should be done. Take care. For more information consult a hematologist online -->