THROMBOTIC DISORDERS

Consider in pts with recurrent episodes of venous thrombosis (i.e., deep-vein thrombosis [DVT], pulmonary embolism [PE]). Causes include (1) venous stasis (e.g., pregnancy, immobilization); (2) vasculitis; (3) cancer and myeloproliferative disorders; (4) oral contraceptives; (5) lupus anticoagulant—antibody to platelet phospholipid, stimulates coagulation; (6) HIT; (7) deficiencies of endogenous anticoagulant factors—antithrombin III, protein C, protein S; (8) factor V Leiden—mutation in factor V (Arg → Glu at position 506) confers resistance to inactivation by protein C, accounts for 25% of cases of recurrent thrombosis; (9) prothrombin gene mutation—Glu → Arg at position 20210 results in increased prothrombin levels; accounts for about 6% of thromboses; (10) other—paroxysmal nocturnal hemoglobinuria, dysfibrinogenemias (abnormal fibrinogen).

The approach to the diagnosis of the pt with DVT and/or PE is discussed in Chap. 135: Pulmonary Thromboembolism and Deep-Vein Thrombosis.