Hypercoagulability presentation
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Hypercoagulability presentation Presentation Transcript

  • 1. CASE PRESENTATION DEPARTMENT 31
  • 2. Personal History Female patient M.A. 65 years old, House wife, married with 14 offspring youngest is 35 years old, living in Elsaff ,with no special habits of medical importance.
  • 3. ComplaintPain and swelling of left leg
  • 4. Present HistoryCondition started 5 days before admission by pain and swelling of left leg of gradual onset and progressive course, the pain was related to calf, not radiating, bursting, increasing by prolonged standing or walking and decreasing by elevation of the affected leg.
  • 5.  The edema was persistent, increasing by standing and decreasing by elevation of the leg.
  • 6.  The condition is not associated with fever, and not preceeded by trauma, surgical operations or intake of any drugs.
  • 7.  The condition is not associated with chest pain, hemoptysis or dyspnea.
  • 8. The patient suffered from left hypochondrial stitching pain two Months ago and sought medical care, U/S and CT abdomen were and the condition was diagnosed as multiple splenic and renal infarctions.
  • 9. No history of: Arthralgias or arthritis Photosenstivity Oral ulcers Excessive hairfall
  • 10.  No history of: Rapid weight loss Generalized body swellings Severe headache, projectile vomiting or blurring of vision.
  • 11.  Chest pain or hemoptysis. Right hypochondrial pain or jaundice. Persistent bony pains. No history of previous strokes, TIAs, myocardial infarctions, intestinal infarctions or limb ischemia.
  • 12.  No history suggestive of other systemic diseases. The patient is not known to be hypertensive.
  • 13. Past Historyhistory of previous similar condition.History of cataract operation done 20 years ago.
  • 14. Family HistoryNo similar conditions in the family.Positive consanguinity.( The parents are cousins.)
  • 15. ObstetricNo history of previous abortions
  • 16. EXAMINATION
  • 17.  The patient is fully concious, of average mood, and well oriented to time, place and person.
  • 18. ExaminationVital Signs:B.p.:120/80Pulse:80, Regular, of average pulse volume, equalbilaterally, with no special character. Peripheralpulsations are intact. Arterial wall is not felt.Temp: 37.5R.R.: 20RBS:269
  • 19. No jaundice No Pallor No cyanosisCarotid pulsations are of average volume andequal bilaterallyNo congested neck veinsNo thyroid swellingNo cervical lymphadenopathy
  • 20. Limb examinationUpper limbs: No clubbing or cyanosis No flapping tremors or palmar erythema Lower limbs: Left lower limb edema, redness and tenderness Tense calf muscles of the left lower limb Palpable dorsalis pedis and posterior tibial
  • 21. Cardiac examinationInspection: Apex lies in the 5th space in the MCL No visible pulsationsPalpation: No palpable pulsations or thrills
  • 22. Auscultation: Normal S1 and S2 No additional heart sounds No murmurs, rub or gallop
  • 23. Chest examinationInspection: No scars or sinuses or pigmentationPalpation: No tenderness Normal TVF
  • 24. Percussion: Normal lung resonance Upper border of the liver in the 5th MCL Auscultation: Normal vesicular breathing No wheezes or crepitations No bilateral basal crepitations
  • 25. Abdominal examinationInspection: No pigmentation, scratching marks or sinuses Palpation: Superficial palpation: No rigidity, tenderness or rebound tenderness. No superficial masses.
  • 26. Deep palpation: No palpable organomegaly. Percussion: No detectable ascites Auscultation: Audible intestinal sounds
  • 27. Neurological examination Intact cranial nerves. Normal tone, power and reflexes. Intact sensation. Normal coordination.
  • 28. Joint examinationNormal range of movement of all joints.No redness or tenderness of any joints.
  • 29. Lymph node examination No cervical, axillary or inguinal lymphadenopathy.
  • 30. Musculoskeletal examination No sternal tenderness.
  • 31. INVESTIGATIONS
  • 32. LABS
  • 33. ESR FIRSTHOUR : 52SECONDHOUR: 89
  • 34. CBCTLC 7.9RBC’S 3.86Hemoglobin 10.1Haematocrit 30.9M.C.V 79.9M.C.H 26M.C.H.C 32.6RDW 16.5PLATELETS COUNT 129
  • 35.  Mild microcytic hypochromic anemia. RBCs show anisocytosis. Mild thrombocytopenia.
  • 36. Coagulation profile PT : 23.8 PC : 31.3 % INR: 1.88 PTT: 38 ( 28-40 sec.)
  • 37. ChemistryBIL-T 1.24 Phosphorus 3BIL-D 0.56 LDH 369ALAT 33 (135-225)AST 40Albumin 3.6 Na 143TGs 89 K 3.8Cholesterol 188 T.Ptn 6.2Urea 28 Alb 3.3Creatinine 0.9 FBS 157Calcium 8.7
  • 38. Urine analysisColor : yellow Pus cells : 8-10Reaction: Acidic RBCs : 10-15 Crystals : NilSp.gravity : 1015 Casts : NilProteins : + Epithilial cells: NilSugar : NilAcetone : NilBile pigment : Nil
  • 39. Immune profile ANA : +ve speckled and nucleolar C4 : 39.9 ( 10-40) C3 : 159 (90-180) Anti-ds DNA : Pending ANCA : Pending
  • 40.  Lupus anticoagulant : 133 Anticardiolipin : Pending Anti-B2-glycoprotein 1 IgG AM screen : 56 (Up to 10 )
  • 41.  Protein C : 37 ( 82-110) Protein S: 61 ( 71-113)
  • 42. Tumor markers AFP : 2.5 CA 15-5 : Pending CA19-9 : Pending CA125 : Pending
  • 43. IMAGING
  • 44. Duplex
  • 45. Ultrasound
  • 46. CT Neck
  • 47. CT chest
  • 48. CT abdomen