A 25-year-old woman was admitted to the hospital with a pulmonary embolism after

Question

A 25-year-old woman was admitted to the hospital with a pulmonary embolism after an overseas flight. Heparin and Coumadin were started immediately. Her baseline coagulation tests were all normal. Twenty-four hours later, her coagulation tests were as follows: PT: 12.3 sec aPTT: 39.0 sec PLT: 198 ? 109/L 1. Interpret the coagulation results. 2. What additional tests should be performe? Antithrombin assay Evaluate the results of the following additional studies: Antithrombin assay: decreased 3. Based on all the data provided, what condition is most likely? 4. What information is most diagnostic? Antithrombin assay 5. Why did the patient fail to respond appropriately to the heparin?

Explanation / Answer

1) pt(prothrombin time) or aptt(activated partial thromboplastin time) is a medical test that characterizes blood coagulation also known as clotting

pt measues overall speed at which blood clots , normal pt range is 11-13.5sec, and normal aptt range is 30-40 sec

pLt or say platelets cont of the women is okay

As said heaprin and coumadin were administered and 24 hr later her pt was 12.3 sec which is normal, aptt was 30sec which is again normal

So the overall results tell that now her values are normal and coagulation values are alright , heparin and coumadin increased the pt aptt which must have been low earlier.

2) Additional tests to be performed are :

1. D-dimer blood test which measures a substance that is released when a blood clot breaks up.

2. CT(computed tomography) scan or CT angiogram

3. MRI(magnetic resonance imaging)

4. Doppler ultrasound

5. Echocardiogram

6. Pulmonary angiogram

Assay of antithrombin activity may be of diagnostic prognosis or prognostic value in some. Heparin therapy may temporarily decrease plasma antithrombin activity into the abnormal range.

3). DIC(disseminated intravascular coagulation) is the most likely condition, treatment includes correction of the cause and replacement of platelets, heparin is used as therapy( or prophylaxis) in patient wuth slowly evolving DIC.

4) most diagnostic information is that the antithrombin assay is decreased

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