Hypercoagulability presentation
- 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. Complaint Pain and swelling of left leg
- 4. Present History Condition 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 History history of previous similar condition. History of cataract operation done 20 years ago.
- 14. Family History No similar conditions in the family. Positive consanguinity.( The parents are cousins.)
- 15. Obstetric No history of previous abortions
- 16. EXAMINATION
- 17. The patient is fully concious, of average mood, and well oriented to time, place and person.
- 18. Examination Vital Signs: B.p.:120/80 Pulse:80, Regular, of average pulse volume, equal bilaterally, with no special character. Peripheral pulsations are intact. Arterial wall is not felt. Temp: 37.5 R.R.: 20 RBS:269
- 19. No jaundice No Pallor No cyanosis Carotid pulsations are of average volume and equal bilaterally No congested neck veins No thyroid swelling No cervical lymphadenopathy
- 20. Limb examination Upper 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 examination Inspection: Apex lies in the 5th space in the MCL No visible pulsations Palpation: No palpable pulsations or thrills
- 22. Auscultation: Normal S1 and S2 No additional heart sounds No murmurs, rub or gallop
- 23. Chest examination Inspection: No scars or sinuses or pigmentation Palpation: 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 examination Inspection: 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 examination Normal 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 FIRST HOUR : 52 SECOND HOUR: 89
- 34. CBC TLC 7.9 RBC’S 3.86 Hemoglobin 10.1 Haematocrit 30.9 M.C.V 79.9 M.C.H 26 M.C.H.C 32.6 RDW 16.5 PLATELETS 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. Chemistry BIL-T 1.24 Phosphorus 3 BIL-D 0.56 LDH 369 ALAT 33 (135-225) AST 40 Albumin 3.6 Na 143 TGs 89 K 3.8 Cholesterol 188 T.Ptn 6.2 Urea 28 Alb 3.3 Creatinine 0.9 FBS 157 Calcium 8.7
- 38. Urine analysis Color : yellow Pus cells : 8-10 Reaction: Acidic RBCs : 10-15 Crystals : Nil Sp.gravity : 1015 Casts : Nil Proteins : + Epithilial cells: Nil Sugar : Nil Acetone : Nil Bile 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
- 47. Ultrasound
- 48. CT Neck
- 50. CT chest
- 52. CT abdomen