scholarly journals Thrombocytopenia and Deep Vein Thrombosis on the Top of an Iceberg

Author(s):  
Morteza Daraei ◽  
Sahar Karimpour Reyhan ◽  
Mahsa Abbaszadeh ◽  
Ali Afshari

Systemic Lupus Erythematous (SLE) is a chronic autoimmune disorder with a relapsingremitting course. Besides, SLE most commonly occurs in child-bearing-age women. Due to protean manifestations, the diagnosis may be challenging; however, a high index of suspicion, i.e. achieved by experience and perceptivity is the key to a correct decision. Here, we present an SLE patient; her initial symptoms resembled a malignant process, but important elements guided us to the underlying autoimmune process. A 34-year-old woman presented with a uterine mass, deep vein thrombosis, and significant thrombocytopenia. Our first impression was malignant processes; however, considering her age with thrombosis and thrombocytopenia as the key components of her presentation, we suspected antiphospholipid syndrome and SLE. Her abdominal mass was a benign leiomyoma. We treated her with glucocorticoids and anticoagulants. Accordingly, after improving cytopenia, we discharged her and the follow-up examination result was satisfactory.

2021 ◽  
pp. 1-2
Author(s):  
Aravind Reddy Kuchkuntla ◽  

Necrotizing fasciitis (NF) has a rapid clinical course and is associated with high mortality. Moreover, it involves a high index of suspicion and early aggressive intervention to reduce the risk of mortality. The overlap in clinical presentation in similar pathologies like abscesses, cellulitis, and deep vein thrombosis, can mask underlying NF, making the diagnosis even more challenging. This case presents multiple comorbidities that expedited the development of NF, while demonstrating a pragmatic approach to treating NF while balancing anticoagulation and emergent surgical intervention. The utilization of clinical judgement and a risk stratification score can help identify early cases of NF allowing for aggressive intervention.


Author(s):  
Binal Nitin Lodaria ◽  
Prasad Muley ◽  
Dhrumika Sheth

India is a densely populated developing country and accounts for one quarter of the total tuberculosis cases reported worldwide. Deep vein thrombosis (DVT) has been associated with 1.5-3.4% cases of tuberculosis. A 14 year female presented with complaints of cough with progressive breathlessness (NYHA Grade III) since 15 days along with easy fatiguability and fever for 3 days. The patient was started on Anti-Tubercular Treatment (ATT) as per RNTCP guidelines after thorough investigations. One week after the patient was started on ATT, the patient developed edema of the right lower limb accompanied by pain. Color doppler was suggestive of thrombosis in the superficial and deep veins. Early immobilization and physiotherapy was started immediately. Over a period of 10 days, the swelling gradually decreased, and pain subsided. Tuberculosis is an independent risk factor for the development of venous thromboembolism irrespective of the presence of other risk factors. Emphasis is thus laid on high index of suspicion and early diagnosis to control and prevent further complications like pulmonary embolism. We can propose that in patients diagnosed with pulmonary tuberculosis, early immobilization and physiotherapy can prevent the development of DVT.


2020 ◽  
Vol 1 (1) ◽  
pp. 11-15
Author(s):  
Sandhya Venugopal ◽  

Non-bacterial thrombotic endocarditis (NBTE) is characterized by vegetations on cardiac valves consisting of fibrin and platelet aggregates that are devoid of inflammation or bacteria. Diagnosis is often challenging and is aided by a high index of suspicion. These factors are reflected by the case of a 53 year old woman with a history of recurrent idiopathic deep vein thrombosis (DVT) prior to presentation at our institution to which she was admitted because of right upper extremity numbness and weakness.


1998 ◽  
Vol 79 (03) ◽  
pp. 517-519 ◽  
Author(s):  
Stephane Heymans ◽  
Raymond Verhaeghe ◽  
Luc Stockx ◽  
Désiré Collen

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.


1991 ◽  
Vol 66 (04) ◽  
pp. 426-429 ◽  
Author(s):  
Marcel Levi ◽  
Anthonie W A Lensing ◽  
Harry R Büller ◽  
Paolo Prandoni ◽  
Gerard Dooijewaard ◽  
...  

SummaryIn the present study 57 consecutive patients with a first episode of venographically proven deep vein thrombosis were investigated to evaluate the release of tissue-type plasminogen activator (t-PA) and of urokinase-type plasminogen activator (u-PA) in response to DDAVP stimulation as well as the resting plasminogen activator inhibitor (PAI) concentration, comparing this to the results obtained in 66 similar patients with a clinical suspicion of thrombosis but with a normal venogram. All assays were performed without knowledge of the patient's status.Four patients in the deep vein thrombosis-group (7%) had an absent u-PA antigen response upon DDAVP infusion, while a normal response was observed in all control subjects. Patients and controls showed similar increases in t-PA antigen level upon DDAVP. High resting PAI antigen levels were encountered in 5 patients in the deep vein thrombosis-group (9%) and in 6 subjects in the control group (9%).The results from this controlled study indicate that a defective release of u-PA may occur in patients with deep vein thrombosis and may have pathogenetic significance. Furthermore it is concluded that elevation of PAI levels cannot be considered as a specific risk factor for venous thrombosis.


1974 ◽  
Vol 32 (02/03) ◽  
pp. 468-482 ◽  
Author(s):  
O Storm ◽  
P Ollendorff ◽  
E Drewsen ◽  
P Tang

SummaryThe thrombolytic effect of pig plasmin was tested in a double blind trial on patients with deep venous thrombosis in the lower limb. Only patients with not more than three days old thrombi were selected for this study. The diagnosis of deep vein thrombosis was made clinically and confirmed by phlebography. Lysofibrin Novo (porcine plasmin) or placebo (porcine plasminogen) was administered intravenously to the patients. The enzyme and the placebo were delivered as lyophilized powder in labelled bottles - the contents of the bottles were unknown to the doctor in charge of the clinical administration of the trial. An initial dose of plasmin/plasminogen of 30 unit per kg body weight given slowly intravenously (1-1% hours infusion) was followed by a maintenance dosis of 15 per cent the initial dose per hour for the following 5-7 hours. In most cases a similar maintenance dosis was given the next day. In all patients heparin was administered after ending the plasmin/plasminogen infusion. The results of the treatment was evaluated clinically as well as by control phlebo- grams the following days.A statistically significant improvement was found in the plasmin treated group compared with the placebo (plasminogen) treated group. Thrombolysis was obtained clinically and phlebographically in 65 per cent of the plasmin treated group, but only in 15 per cent of the control patients were improvements found.This study has thus demonstrated that plasmin treatment according to a standard scheme was able to induce thrombolysis. There were only a few and insignificant side effects. Allergic reactions have not been seen and only very simple tests are required.


1990 ◽  
Vol 64 (04) ◽  
pp. 497-500 ◽  
Author(s):  
Martin H Prins ◽  
Jack Hirsh

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.


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