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Coagulation Case Studies

Monday, December 1, 2008

December Case Study

After a large holiday meal and falling asleep watching television your sedentary, obese cousin wakes up with severe pain in his right calf. He tries to walk off the pain, but it persists. The site is red and hot, clearly inflamed. This continues and it is decided to take him to the hospital. Since it is a holiday the emergency room is very busy, with a skeleton crew.

Upon examination, the resident looks at the situation and suspects a DVT. Since getting imaging will be a while,(due to the holiday) he immediately decides to give the patient a dose of unfractionated heparin.

Several hours after the heparin is given, blood is drawn. Your cousin wants to go home, but they are afraid he will get a PE, so they wait for test results. (It is a holiday...) They give another dose of heparin.

The results were as follows:
PT= 11.4 sec
APTT = 62.8 sec
Fibrinogen = 525
Platelets= 657, 000
D dimer = 786 FEU
APCR = negative
LA = negative
Protein C= 78% (80-120%)
Protein S = 48% (65-135%)

He was admitted due to a Protein S deficiency-
Is this correct, and what is the next course of action?

Donna Castellone

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Donna Castellone,  MS, MT(ASCP)SH

Donna Castellone,

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