Question

A 44-year-old female of northern European descent was admitted to the emergency department with se- vere abdominal pain. History revealed treatment for deep vein thrombosis at age 30. She was treated with warfarin but had recently not been taking her medication. A thrombosis in an abdominal vein was confirmed by radiographic studies. The patient was placed on heparin, which stopped any further thrombosis. The coagulation workup is as follows: Platelet Count = 135 x 109/L Protime = 15.5 sec Fibrinogen = 225 mg/L APTT = 37 sec D-Dimer = 150 ng/mL 1. Explain any abnormal coagulation workup results. 2- What additional specialty laboratory assays are needed to identify the problem?

Answer 1

1)Platelet count is 135× 109/L which is less than the normal value (150- 400 × 109/L)

Protime is 15.5 sec.which is higher than the normal value (11-12.5 sec.) . It means blood is taking longer time than normal to clot.

All other value are under normal range.

2) A complete Blood count should be done to culcucalc Neutrophil to lymphocyte ratio(NLR) and Platelet to lymphocyte ratio(PLR).The NLR can be useful to rule Deep vein thrombosis when it is negative where PLR can be useful in ruling DVT when positive.

Duplex Ultrasonography should be done to look at the flow of blood in vein and detect blockages or blot clot in deep vein.